Aurelien Amiot1, Vida Setakhr2, Philippe Seksik3, Mathieu Allez4, Xavier Treton5, Martine De Vos6, David Laharie7, Jean-Frederic Colombel8, Vered Abitbol9, Jean Marie Reimund10, Jacques Moreau11, Michel Veyrac12, Bernard Flourié13, Jacques Cosnes3, Marc Lemann4, Yoram Bouhnik5. 1. 1] Department of Gastroenterology, Henri Mondor Hospital, UPEC, Creteil, France [2] These authors contributed equally to this work. 2. 1] Department of Gastroenterology, IBD and Nutrition Support, Beaujon Hospital, University Paris 7 Denis Diderot, Clichy, France [2] These authors contributed equally to this work. 3. Department of Gastroenterology, Saint-Antoine Hospital, University Paris 6 Pierre and Marie Curie, Paris, France. 4. Department of Gastroenterology, Saint-Louis Hospital, University Paris 7 Denis Diderot, Paris, France. 5. Department of Gastroenterology, Henri Mondor Hospital, UPEC, Creteil, France. 6. Department of Gastroenterology, Gent Hospital, University of Gent, Gent, Belgium. 7. Department of Gastroenterology, Haut-Leveque Hospital, University of Bordeaux 2, Pessac, France. 8. Department of Gastroenterology, Claude Huriez Hospital, University of Lille 2, Lille, France. 9. Department of Gastroenterology, Cochin Hospital, University Paris 5 Descartes, Paris, France. 10. Department of Gastroenterology, Cote de Nacre Hospital, University of Caen, Caen, France. 11. Department of Gastroenterology, Rangueil University Hospital, University of Toulouse, Toulouse, France. 12. Department of Gastroenterology, Montpellier University Hospital, University of Montpellier, Montpellier, France. 13. Department of Gastroenterology, Edouard Herriot Hospital, University Lyon 1 Claude Bernard, Lyon, France.
Abstract
OBJECTIVES: Although anti-tumor necrosis factor (TNF) therapy is the treatment of choice for perianal fistulizing Crohn's disease (CD), the efficacy and safety of anti-TNF therapy in enterocutaneous fistula (ECF) remains unclear. METHODS: Between January 2008 and December 2009, we retrospectively reviewed the outcomes of all CD patients with ECF (excluding perianal fistula) treated with anti-TNF therapy followed up in Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID) centers. ECF closure and tolerance of anti-TNF therapy were studied using univariate and multivariate analyses. RESULTS: Forty-eight patients (twenty-six women; median age 34.6 (interquartile range=25.0-45.5) years) were included in this study. The median follow-up period was 3.0 (2.0-6.6) years. The fistula was located in the small bowel (n=38), duodenum (n=1), and colon (n=9). The fistula has been developed in ileocolonic anastomosis in 17 (35%) cases. Sixteen patients (33%) had complex fistulas with multiple tracts and eleven patients (23%) had a high ECF output (if wearing an ostomy bag). Complete ECF closure was achieved in 16 (33%) patients, of whom eight relapsed during the follow-up period. In multivariate analysis, complete ECF closure was associated with the absence of multiple ECF tracts and associated stenosis. An abdominal abscess developed in 15 (31%) patients. ECF resection was needed in 26 (54%) patients. One patient died after surgery owing to abdominal sepsis. CONCLUSIONS: In CD patients with ECF, anti-TNF therapy may be effective in up to one-third of patients, especially in the absence of stenosis and complex fistula. A careful selection of patients is mandatory to prevent treatment failure and improves the safety.
OBJECTIVES: Although anti-tumor necrosis factor (TNF) therapy is the treatment of choice for perianal fistulizing Crohn's disease (CD), the efficacy and safety of anti-TNF therapy in enterocutaneous fistula (ECF) remains unclear. METHODS: Between January 2008 and December 2009, we retrospectively reviewed the outcomes of all CDpatients with ECF (excluding perianal fistula) treated with anti-TNF therapy followed up in Groupe d'Etude Thérapeutique des Affections Inflammatoires du tube Digestif (GETAID) centers. ECF closure and tolerance of anti-TNF therapy were studied using univariate and multivariate analyses. RESULTS: Forty-eight patients (twenty-six women; median age 34.6 (interquartile range=25.0-45.5) years) were included in this study. The median follow-up period was 3.0 (2.0-6.6) years. The fistula was located in the small bowel (n=38), duodenum (n=1), and colon (n=9). The fistula has been developed in ileocolonic anastomosis in 17 (35%) cases. Sixteen patients (33%) had complex fistulas with multiple tracts and eleven patients (23%) had a high ECF output (if wearing an ostomy bag). Complete ECF closure was achieved in 16 (33%) patients, of whom eight relapsed during the follow-up period. In multivariate analysis, complete ECF closure was associated with the absence of multiple ECF tracts and associated stenosis. An abdominal abscess developed in 15 (31%) patients. ECF resection was needed in 26 (54%) patients. One patient died after surgery owing to abdominal sepsis. CONCLUSIONS: In CDpatients with ECF, anti-TNF therapy may be effective in up to one-third of patients, especially in the absence of stenosis and complex fistula. A careful selection of patients is mandatory to prevent treatment failure and improves the safety.
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