Positioning strictureplasty in the treatment of extensive Crohn’s disease ileitis: a comparative study with ileocecal resection

Abstract

Purpose

The optimal surgical approach to extensive Crohn’s disease (CD) terminal ileitis is debated. To date, no studies have directly compared the short- and long-term outcomes of modified side-to-side isoperistaltic strictureplasty over the valve (mSSIS) to traditional ileocecal resection.

Methods

A retrospective, observational, comparative study was conducted in consecutive CD patients operated for extensive involvement of the terminal ileum (≥ 20 cm). Ninety-day postoperative morbidity was assessed using the comprehensive complication index (CCI). Surgical recurrence was defined as the need for any surgical intervention related to CD during the follow-up period. Endoscopic remission was defined as ≤ i2a, according to the modified Rutgeerts score. Deep remission was defined as the combination of endoscopic remission and absence of clinical symptoms. Perioperative factors related to clinical recurrence were evaluated.

Results

Eighty-seven patients were included (47 (54%) ileocecal resection and 40 (46%) mSSIS). Median follow-up was 56 (IQR 34.7–94.4) and 72 (IQR 48.3–87.2) months for resection and mSSIS, respectively (p < 0.001). No mortality occurred. Mean CCI was 9.1 vs 8.5 for ileocecal resection and mSSIS, respectively (p = 0.48). Throughout the follow-up, 8 patients in the resection group (17%) and 5 patients in the mSSIS group (12.5%) experienced surgical recurrence (p = 0.393). Thirty-seven (92.5%) of patients kept the mSSIS. No difference in deep remission was observed (41% vs 22.5%, p = 0.34).

Conclusions

Modified SSIS seems to be non-inferior in terms of safety, recurrence, and durability to traditional resections with the advantage of mitigating the risk of a short bowel syndrome. Larger prospective studies are required to confirm these findings.

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Data availability

Institutional database

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Acknowledgments

Marc Ferrante and Severine Vermeire are senior clinical investigators of the Research Foundation Flanders (FWO).

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Correspondence to Gabriele Bislenghi.

Ethics declarations

This research study was conducted retrospectively from data obtained for clinical purposes with all the procedures being performed were part of the routine care. Approval was obtained from the ethics committee of University of Leuven (S53684).

All patients had consented for their data to be analyzed through the VLECC Biobank (Vlaamse Erfelijkheidsstudie Crohn’s en Colitis Ulcerosa, of Flemish Study for Genetics Research on Crohn’s Disease and Ulcerative Colitis).

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Further, all the possible conflicts of interest are now disclosed:

Marc Ferrante:

Research grant: Amgen, Biogen, Janssen, Pfizer, Takeda

Consultancy: Abbvie, Boehringer-Ingelheim, Janssen, MSD, Pfizer, Sandoz, Takeda, Thermofisher

Speakers fee: Abbvie, Amgen, Biogen, Boehringer-Ingelheim, Falk, Ferring, Janssen, Lamepro, MSD, Mylan, Pfizer, Sandoz, Takeda

Severine Vermeire:

Receipt of grants/research supports: MSD, Abbvie, Takeda, Janssen, Pfizer

Receipt of honoraria or consultation fees: AbbVie, MSD, Takeda, Ferring, Genentech/Roche, Shire, Pfizer Inc, Galapagos, Mundipharma, Hospira, Celgene, Second Genome, Progenity, Lilly, Arena, Gilead and Janssen

Participation in a company sponsored speaker’s bureau: AbbVie, MSD, Takeda, Ferring, Hospira, Pfizer, Janssen, and Tillots

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Bislenghi, G., Fieuws, S., Wolthuis, A. et al. Positioning strictureplasty in the treatment of extensive Crohn’s disease ileitis: a comparative study with ileocecal resection. Int J Colorectal Dis (2021). https://doi.org/10.1007/s00384-021-03837-6

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Keywords

  • Crohn’s disease
  • Ileitis
  • Strictureplasty
  • Ileocecal resection
  • Recurrence