Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease
Despite the increasing incidence and prevalence of Crohn’s Disease (CD), no curative options exist and treatment remains complex. While therapy has mainly focused on medical approaches in the past, growing evidence reveals that in cases of limited inflammation, surgery can suffice as an alternative...
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doaj-6e319b01b1a34ba5a7d79739111f96592021-02-13T00:02:59ZengMDPI AGJournal of Clinical Medicine2077-03832021-02-011073173110.3390/jcm10040731Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s DiseaseMatthias Kelm0Friedrich Anger1Robin Eichlinger2Markus Brand3Mia Kim4Joachim Reibetanz5Katica Krajinovic6Christoph-Thomas Germer7Nicolas Schlegel8Sven Flemming9Department of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanySection of Gastroenterology, Department of Internal Medicine II, Center of Internal Medicine (ZIM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDepartment of General, Visceral, Transplantation, Vascular and Pediatric Surgery, Center of Operative Medicine (ZOM), University Hospital of Wuerzburg, 97080 Wuerzburg, GermanyDespite the increasing incidence and prevalence of Crohn’s Disease (CD), no curative options exist and treatment remains complex. While therapy has mainly focused on medical approaches in the past, growing evidence reveals that in cases of limited inflammation, surgery can suffice as an alternative primary treatment. We retrospectively assessed the disease course and outcomes of 103 patients with terminal Ileitis who underwent primary surgery (<i>n</i> = 29) or received primary medical treatment followed by surgery (<i>n</i> = 74). Primary endpoint was the need for immunosuppressive medication after surgical treatment (ileocecal resection, ICR) during a two-years follow-up. Rates for laparoscopic ICR were enhanced in case of early surgery, but no differences were seen for postoperative complications. In case of immunosuppressive medication, patients with ICR at an early state of disease needed significantly less anti-inflammatory medication during the two-year postoperative follow-up compared to patients who were primarily treated medically. Furthermore, in a subgroup analysis for patients with localized ileocecal disease manifestation, early surgery consistently resulted in a decreased amount of medical therapy postoperatively. In conclusion primary ICR is safe and effective in patients with limited CD, and the need for immunosuppressive medication during the postoperative follow-up is low compared to patients receiving surgery at a later stage of disease.https://www.mdpi.com/2077-0383/10/4/731Crohn’s Diseasesurgical therapyileocecal resection |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Matthias Kelm Friedrich Anger Robin Eichlinger Markus Brand Mia Kim Joachim Reibetanz Katica Krajinovic Christoph-Thomas Germer Nicolas Schlegel Sven Flemming |
spellingShingle |
Matthias Kelm Friedrich Anger Robin Eichlinger Markus Brand Mia Kim Joachim Reibetanz Katica Krajinovic Christoph-Thomas Germer Nicolas Schlegel Sven Flemming Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease Journal of Clinical Medicine Crohn’s Disease surgical therapy ileocecal resection |
author_facet |
Matthias Kelm Friedrich Anger Robin Eichlinger Markus Brand Mia Kim Joachim Reibetanz Katica Krajinovic Christoph-Thomas Germer Nicolas Schlegel Sven Flemming |
author_sort |
Matthias Kelm |
title |
Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease |
title_short |
Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease |
title_full |
Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease |
title_fullStr |
Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease |
title_full_unstemmed |
Early Ileocecal Resection Is an Effective Therapy in Isolated Crohn’s Disease |
title_sort |
early ileocecal resection is an effective therapy in isolated crohn’s disease |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2021-02-01 |
description |
Despite the increasing incidence and prevalence of Crohn’s Disease (CD), no curative options exist and treatment remains complex. While therapy has mainly focused on medical approaches in the past, growing evidence reveals that in cases of limited inflammation, surgery can suffice as an alternative primary treatment. We retrospectively assessed the disease course and outcomes of 103 patients with terminal Ileitis who underwent primary surgery (<i>n</i> = 29) or received primary medical treatment followed by surgery (<i>n</i> = 74). Primary endpoint was the need for immunosuppressive medication after surgical treatment (ileocecal resection, ICR) during a two-years follow-up. Rates for laparoscopic ICR were enhanced in case of early surgery, but no differences were seen for postoperative complications. In case of immunosuppressive medication, patients with ICR at an early state of disease needed significantly less anti-inflammatory medication during the two-year postoperative follow-up compared to patients who were primarily treated medically. Furthermore, in a subgroup analysis for patients with localized ileocecal disease manifestation, early surgery consistently resulted in a decreased amount of medical therapy postoperatively. In conclusion primary ICR is safe and effective in patients with limited CD, and the need for immunosuppressive medication during the postoperative follow-up is low compared to patients receiving surgery at a later stage of disease. |
topic |
Crohn’s Disease surgical therapy ileocecal resection |
url |
https://www.mdpi.com/2077-0383/10/4/731 |
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