Limited ileo-caecal resection for localised Crohn's disease in childhood: Clinical outcome and predictors of further surgery

Does Ileocecal Resection Affect Children's Medium-Long-Term Growth and Defecation Patterns? A Matched Case-Control Study

BACKGROUND

Ileocecal resection leads to some early complications, but it is unknown whether it affects children's medium-long-term growth and defecation patterns. To determine if there was an association, we conducted this matched case-control study.

METHODS

This study was conducted in Beijing Children's Hospital and included three groups: the case group (n = 30) included patients with ileocecal duplication undergoing ileocecal resection between January 2010 and June 2021, the control group (n = 90) included outpatient patients without ileocecal resection in January 2022, and the appendectomy group (n = 90) included patients who underwent appendectomy between January 2010 and June 2021. The 1:1 matching criteria included gender and age (within 1 year). The evaluation indicators were growth (height-for-age, BMI) and defecation patterns (stool frequency, stool consistency) over 6 months after surgery. Defecation patterns were assessed in patients older than 4 years. Stool consistency was evaluated by the modified Bristol Stool Form Scale.

RESULTS

There were no significant differences, except for stool consistency, between the case and control groups regarding their growth and defecation patterns before case-control matching. The patients in the case group had a significantly higher prevalence of dry stool (P < 0.008). After case-control matching, there were no significant differences in the growth and defecation patterns between the case and control groups. Before and after case-control matching, there were no significant differences in the defecation patterns between the control group and the appendectomy group.

CONCLUSION

Children's medium-long-term growth and defecation patterns were not affected by ileocecal resection.

Anti-TNFα Treatment After Surgical Resection for Crohn's Disease Is Effective Despite Previous Pharmacodynamic Failure

BACKGROUND

The outcome of patients with Crohn's disease who failed anti-tumor necrosis factor alpha (anti-TNFα) therapy despite adequate serum drug levels (pharmacodynamic failure) is unclear. We aimed to assess such pediatric patients who underwent intestinal resection and were re-treated with the same anti-TNFα agent postoperatively.

METHODS

Pediatric patients with Crohn's disease who underwent intestinal resection and were treated with anti-TNFα agents postoperatively were assessed retrospectively. Patients were stratified to those with preoperative anti-TNFα pharmacodynamic failure and those with no preoperative anti-TNFα treatment.

RESULTS

A total of 53 children were included, 18 with pharmacodynamic failure and 35 controls. Median age at intestinal resection was 14.8 years with 23 (43%) girls. The median time from intestinal resection to anti-TNFα initiation was 8 months (interquartile range 4-14 months). At the time of postoperative anti-TNFα initiation there were no differences in clinical, laboratory, and anthropometric measures between groups. Similar proportions of patients from both groups were in clinical remission on anti-TNFα treatment after 12 months and at the end of follow-up (1.8 years, interquartile range, 1-2.9 years): 89% versus 88.5% and 83% versus 80% for pharmacodynamic failure patients and controls, respectively; P = 0.9. No significant differences were observed at 14 weeks and 12 months of postoperative anti-TNFα treatment including endoscopic remission rate and fecal calprotectin. Both groups significantly improved all measures during postoperative anti-TNFα treatment.

CONCLUSIONS

Pediatric patients with Crohn's disease who failed anti-TNFα therapy despite adequate drug levels and underwent intestinal resection can be re-treated with the same agent for postoperative recurrence with high success rate similar to that of anti-TNFα naive patients.

Long-term outcomes after elective ileocecal resection in children with active localized Crohn's disease--a multicenter European study

PURPOSE

The aim of this study was to investigate the therapeutic role of an elective ileocecal resection in children with active localized Crohn's disease.

METHODS

This was a retrospective multicenter study which included five European referral centers which included all children with Crohn's disease who underwent ileocecal surgery from 2000 to 2011 and had a minimum of 12 months follow-up.

RESULTS

Altogether 68 patients fulfilled inclusion criteria. Median age at diagnosis was 13.7 years (6.6-17.9 years) and at surgery 15.2 years (8.6-18.5 years). Median duration of postoperative clinical remission was 20 months (3-95 months). Overall 54 patients (79.4%) were in remission one year after surgery and 38 (55.9%) during the total postsurgical follow up (median 30 months; range 12-95 months). Z score height for age significantly improved postoperatively in children who were at the time of surgery younger than 16 years of age (mean difference 0.232 SD; p=0.029). Cox proportional hazard regression model failed to indicate risk factors associated with postsurgical relapse.

CONCLUSION

Elective ileocecal resection is a valid treatment option which should be considered in a subset of pediatric patients with localized Crohn's disease with the aim of achieving clinical remission and to improve growth.