Long-term outcome of Crohn's disease patients with upper gastrointestinal stricture: A GETAID study. Issue 11 (November 2020)

• Record Type: Journal Article
• Authors: Lambin, Thomas; Amiot, Aurélien; Stefanescu, Carmen; Gornet, Jean-Marc; Seksik, Philippe; Laharie, David; Reenaers, Catherine; Bourreille, Arnaud; Cadiot, Guillaume; Carbonnel, Franck; Dib, Nina; Fumery, Mathurin; Gilletta de St Joseph, Cyrielle; Filippi, Jérôme; Viennot, Stéphanie; Plastaras, Laurianne; Coffin, Benoit; Serrero, Mélanie; Nahon, Stéphane; Pineton de Chambrun, Guillaume; Rahier, Jean-François; Roblin, Xavier; Boualit, Médina; Bouguen, Guillaume; Peyrin-Biroulet, Laurent; Pariente, Benjamin
• Is Part Of: Digestive and liver disease. Volume 52:Issue 11(2020)
• Page Start: 1323
• Page End: 1330
• Publication Date: 2020-11
• Subjects: Crohn's disease -- Upper gastrointestinal tract -- Stricture -- Surgery -- Endoscopic treatment; 5-ASA 5-aminosalicylic acid -- CD Crohn's disease -- CI confidence interval -- CRP C-reactive protein -- EBD endoscopic balloon dilation -- GEA gastroenteroanastomosis -- IQR interquartile range -- HBI Harvey-Bradshaw Index -- OR odds ratio -- TNF tumor necrosis factor -- UGT upper gastrointestinal tract; Digestive organs -- Diseases -- Periodicals; Liver -- Diseases -- Periodicals; 616.33005
• DOI: 10.1016/j.dld.2020.08.034
• Languages: English
• ISSNs: 1590-8658

Abstract

Abstract: Background: There are few data concerning patients with Crohn's disease (CD) complicated by a stricture of the upper gastrointestinal tract (UGT). Aims: We evaluated the outcome and management of CD patients complicated by a stricture of the UGT. Methods: We performed a retrospective multicenter study including all CD patients with a non-passable symptomatic UGT stricture on endoscopy. Primary outcome measure was surgery-free survival from diagnosis of stricture. Efficacy of medical, endoscopic, and surgical treatments, and identification of predictors of surgery were also evaluated. Results: 60 CD patients with an UGT stricture were included. 60% of the strictures were located in the duodenum. With a median follow-up of 5.5 (IQR: 3.0–12.0) years since stricture diagnosis, surgical-free survival was 75% and 64% at 1 and 5 years, respectively. At the end of the follow up, 27 (45%) patients underwent surgery. 77 endoscopic procedures were performed in 30 patients with an immediate success of 81% and a clinical benefit in 84% of the procedures. In multivariate analysis, anti-TNF treatment initiation was associated with a reduced risk of surgery. Conclusion: CD UGT strictures are mainly located in the duodenum. Medical and endoscopic treatments allow to avoid surgery in half of the patients