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The role of a defunctioning stoma for colonic and perianal Crohns disease in the biological era
Hospital University of Vall Hebron, Spain; Oxford University Hospital, England.
Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Surgery, Orthopaedics and Cancer Treatment, Department of Surgery in Linköping. Oxford University Hospital, England.
Oxford University Hospital, England.
Oxford University Hospital, England.
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2017 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 52, no 3, 251-256 p.Article in journal (Refereed) Published
Abstract [en]

Objective: A defunctioning stoma is a therapeutic option for colonic or perianal Crohns disease. In the pre-biologic era the response rate to defunctioning in our unit was high (86%), but intestinal continuity was only restored in 11-20%. Few data exist on the outcome of defunctioning since the widespread introduction of biologicals. Material and methods: All patients undergoing a defunctioning stoma for colonic/perianal Crohns disease since 2003-2011 were identified from a prospective database. Indications for surgery, medical therapy, response to defunctioning and long-term clinical outcome were recorded. Successful restoration of continuity was defined as no stoma at last follow up. Results: Seventy-six patients were defunctioned (57 with biologicals) and at last follow up, 20 (27%) had continuity restored. Early clinical response rate (amp;lt;3 months) was 15/76 (20%) and overall response 31/76 (41%). Complex anal fistulae/stenosis were associated with a very low chance of restoring continuity (10% and 0%, respectively), while colitis was associated with a higher chance of restoring continuity (48%). Endoscopic or histological improvement in colitis after defunctioning was associated with a higher rate of restoring continuity (10/16, 63%) compared to no such improvement (4/15, 27%, p=0.05). Those failing biologics had similar chance of restoration as those not receiving biologics, 15/57 (26%) and 5/19 (26%), respectively. Conclusion: Overall response to colonic defunctioning was 41%. Successful restoration of continuity occurred in 27%, but 48% in the absence of perianal disease. Response is appreciably less in the pre-biologic era, so patient and physician expectations need to be managed appropriately.

Place, publisher, year, edition, pages
TAYLOR & FRANCIS LTD , 2017. Vol. 52, no 3, 251-256 p.
National Category
Gastroenterology and Hepatology
Identifiers
URN: urn:nbn:se:liu:diva-134778DOI: 10.1080/00365521.2016.1205127ISI: 000392488800001PubMedID: 27855530OAI: oai:DiVA.org:liu-134778DiVA: diva2:1077015
Available from: 2017-02-24 Created: 2017-02-24 Last updated: 2017-03-16

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The full text will be freely available from 2017-11-18 10:19
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Myrelid, Pär
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Division of Clinical SciencesFaculty of Medicine and Health SciencesDepartment of Surgery in Linköping
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