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Management and long-term outcomes of Crohn's disease complicated with enterocutaneous fistula: ECUFIT study from GETECCU

Publicated to:Journal of Crohns & Colitis. 16 (7): jjac016-1058 - 2022-08-04 16(7), DOI: 10.1093/ecco-jcc/jjac016

Authors: Barreiro-de Acosta M, Riestra S, Calafat M, Soto MP, Calvo M, Sánchez Rodríguez E, Caballol B, Vela M, Rivero M, Muñoz F, de Castro L, Calvet X, García-Alonso FJ, Utrilla Fornals A, Ferreiro-Iglesias R, González-Muñoza C, Chaparro M, Bujanda L, Sicilia B, Alfambra E, Rodríguez A, Pérez Fernández R, Rodríguez C, Almela P, Argüelles F, Busquets D, Tamarit-Sebastián S, Reygosa Castro C, Jiménez L, Marín-Jiménez I, Alcaide N, Fernández-Salgado E, Iglesias Á, Ponferrada Á, Pajares R, Roncero Ó, Morales-Alvarado VJ, Ispízua-Madariaga N, Sáinz E, Merino O, Márquez-Mosquera L, García-Sepulcre M, Elorza A, Estrecha S, Surís G, Van Domselaar M, Brotons A, de Francisco R, Cañete F, Iglesias E, Vera MI, Mesonero F, Lorente R, Zabana Y, Cabriada JL, Domènech E, Rodríguez-Lago I

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Abstract

Crohn's disease (CD) can develop penetrating complications at any time during the disease course. Enterocutaneous fistulae (ECF) are disease-related complications with an important impact on quality of life. Our aim was to describe the outcomes of this complication, including its medical and/or surgical management and their temporal trends. The primary endpoint was fistula closure, defined as the absence of drainage, with no new abscess or surgery, over the preceding 6 months.Clinical information from all adult patients with CD and at least one ECF -excluding perianal fistulae- were identified from the prospectively-maintained ENEIDA registry. All additional information regarding treatment for this complication was retrospectively reviewed.A total of 301 ECF in 286 patients (January 1970 - September 2020) were analyzed out of 30,088 records. These lesions were mostly located in the ileum (67%) and they had a median of one external opening (range 1-10). After a median follow-up of 146 months (IQR, 69-233), 69% of patients underwent surgery. Fistula closure was achieved in 84%, mostly after surgery, and fistula recurrence was uncommon (13%). Spontaneous and low-output fistulae were associated with higher closure rates (HR 1.51, 95%CI 1.17-1.93, p=0.001, and HR 1.49, 95%CI 1.07-2.06, p=0.03, respectively), this was obtained more frequently with medical therapy once biologicals have been available.ECF complicating CD are rare but entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A significant proportion of patients receiving medical therapy can achieve fistula closure.© The Author(s) 2022. Published by Oxford University Press on behalf of European Crohn’s and Colitis Organisation. All rights reserved. For permissions, please email: journals.permissions@oup.com.

Keywords

AdultCrohn diseaseCrohn's diseaseCrohn’s diseaseEnterocutaneous fistulaFistulaHumansIntestinal fistulaQuality of lifeRectal fistulaRetrospective studiesSurgeryTreatment outcome

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Journal of Crohns & Colitis due to its progression and the good impact it has achieved in recent years, according to the agency WoS (JCR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position 14/93, thus managing to position itself as a Q1 (Primer Cuartil), in the category Gastroenterology & Hepatology.

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 1.58, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-27, the following number of citations:

  • Scopus: 3
  • OpenCitations: 1

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-05-27:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 32.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 31 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 11.15.
  • The number of mentions on the social network X (formerly Twitter): 19 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.