Temporary Faecal Diversion for Refractory Perianal and/or Distal Colonic Crohn's Disease in the Biologic Era: An Updated Systematic Review with Meta-analysis.

IF 8.3 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Journal of Crohns & Colitis Pub Date : 2024-03-01 DOI:10.1093/ecco-jcc/jjad159
Michael Jew, Joseph Meserve, Samuel Eisenstein, Vipul Jairath, Jeffrey McCurdy, Siddharth Singh
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Abstract

Background and aims: We evaluated short- and long-term outcomes of temporary faecal diversion [FD] for management of refractory Crohn's disease [CD], focusing on outcomes in the biologic era.

Methods: Through a systematic literature review until March 15, 2023, we identified 33 studies [19 conducted in the biologic era] that evaluated 1578 patients with perianal and/or distal colonic CD who underwent temporary FD [with intent of restoring bowel continuity] and reported long-term outcomes [primary outcome: successful restoration of bowel continuity, defined as remaining ostomy-free after reconnection at a minimum of 6 months after diversion or at the end of follow-up]. We calculated pooled rates (with 95% confidence interval [CI]) using random effects meta-analysis, and examined factors associated with successful restoration of bowel continuity.

Results: Overall, 61% patients [95% CI, 52-68%; 50% in biologic era] experienced clinical improvement after FD. Stoma takedown was attempted in 34% patients [28-41%; 37% in biologic era], 6-18 months after diversion. Among patients where bowel restoration was attempted, 63% patients [54-71%] had successful restoration of bowel continuity, and 26% [20-34%] required re-diversion. Overall, 21% patients [17-27%; 24% in biologic era] who underwent FD were successfully restored; 34% patients [30-39%; 31% in biologic era] required proctectomy with permanent ostomy. On meta-regression, post-diversion biologic use and absence of proctitis was associated with successful bowel restoration after temporary FD in contemporary studies.

Conclusion: In the biologic era, temporary FD for refractory perianal and/or distal colonic CD improves symptoms in half the patients, and bowel continuity can be successfully restored in a quarter of patients.

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生物时代难治性肛周和/或结肠远端克罗恩病的临时粪便转流治疗:最新系统综述与 Meta 分析。
背景和目的:我们评估了用于治疗难治性克罗恩病(CD)的临时粪便转流术(FD)的短期和长期疗效,重点关注生物制剂时代的疗效:通过对截至 2023 年 3 月 15 日的文献进行系统性回顾,我们确定了 33 项研究(19 项在生物制剂时代进行),这些研究评估了 1578 名肛周和/或远端结肠 CD 患者,这些患者接受了临时粪便转流术[旨在恢复肠道连续性],并报告了长期结果[主要结果:成功恢复肠道连续性,定义为转流后至少 6 个月或随访结束时重新连接后仍无造口]。我们使用随机效应荟萃分析法计算了汇总率(含 95% 置信区间 [CI]),并研究了成功恢复肠道连续性的相关因素:总体而言,61%的患者[95% CI,52%-68%;生物时代为 50%]在接受 FD 后临床症状有所改善。34%的患者[28-41%;生物制剂时代为 37%]在肠道转流术后 6-18 个月尝试过拆开造口。在尝试恢复肠道功能的患者中,63% 的患者[54-71%]成功恢复了肠道连续性,26% 的患者[20-34%]需要再次转流。总体而言,21%[17-27%;生物制剂时代为 24%]接受 FD 的患者成功恢复了肠道功能;34%[30-39%;生物制剂时代为 31%]的患者需要进行直肠切除术和永久性造口术。元回归结果显示,在当代研究中,转流后使用生物制剂和无直肠炎与临时切除术后成功恢复肠道功能有关:结论:在生物制剂时代,针对难治性肛周和/或远端结肠 CD 的临时 FD 可改善半数患者的症状,四分之一的患者可成功恢复肠道连续性。
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来源期刊
Journal of Crohns & Colitis
Journal of Crohns & Colitis 医学-胃肠肝病学
CiteScore
15.50
自引率
7.50%
发文量
1048
审稿时长
1 months
期刊介绍: Journal of Crohns and Colitis is concerned with the dissemination of knowledge on clinical, basic science and innovative methods related to inflammatory bowel diseases. The journal publishes original articles, review papers, editorials, leading articles, viewpoints, case reports, innovative methods and letters to the editor.
期刊最新文献
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