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

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

Autores: 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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Resumen

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.

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