DOP32 Long-term outcomes of enterocutaneous fistula complicating Crohn’s Disease: The ECUFIT study from GETECCU
Rodríguez-Lago, I.(1);García Pérez, C.(2);Calafat, M.(3);Soto, M.P.(4);Calvo, M.(5);Sánchez Rodríguez, E.(6);Caballol, B.(7);Vela, M.(8);Rivero, M.(9);Muñoz, F.(10);De Castro, L.(11);Calvet, X.(12);García-Alonso, F.J.(13);Utrilla Fornals, A.(14);Ferreiro-Iglesias, R.(15);González-Muñoza, C.(16);Chaparro, M.(17);Luis, B.(18);Sicilia, B.(19);Alfambra, E.(20);Rodriguez, A.(21);Pérez Fernández, R.(22);Rodríguez, C.(23);Almela, P.(24);Argüelles, F.(25);Busquets, D.(26);Tamarit-Sebastián, S.(27);Reygosa Castro, C.(28);Jiménez, L.(29);Marín-Jiménez, I.(30);Alcaide, N.(31);Fernández-Salgado, E.(32);Iglesias Gómez, Á.(33);Ponferrada, Á.(34);Pajares, R.(35);Roncero, Ó.(36);Morales-Alvarado, V.J.(37);Cabriada, J.L.(1);Domènech, E.(3);Barreiro-de Acosta, M.(15)
(1)Hospital de Galdakao- Biocruces Bizkaia Health Research Institute, Gastroenterology, Galdakao, Spain;(2)Hospital Universitario Central de Asturias- Instituto de Investigación Sanitaria del Principado de Asturias, Gastroenterology, Oviedo, Spain;(3)Hospital Universitari German Trias i Pujol, Gastroenterology, Badalona, Spain;(4)Hospital Universitario Reina Sofía, Gastroenterology, Córdoba, Spain;(5)Hospital Universitario Puerta de Hierro, Gastroenterology, Mahadahonda, Spain;(6)Hospital Universitario Ramón y Cajal, Gastroenterology, Madrid, Spain;(7)Hospital Clinic, Gastroenterology, Barcelona, Spain;(8)Hospital Universitario Nuestra Señora de Candelaria, Gastroenterology, Santa Cruz de Tenerife, Spain;(9)Hospital Universitario Marqués de Valdecilla, Gastroenterology, Santander, Spain;(10)Hospital Universitario de Salamanca, Gastroenterology, Salamanca, Spain;(11)Hospital Álvaro Cunqueiro, Gastroenterology, Vigo, Spain;(12)Corporació Parc Taulí, Gastroenterology, Sabadell, Spain;(13)Hospital Universitario Río Hortega, Gastroenterology, Valladolid, Spain;(14)Hospital General San Jorge, Gastroenterology, Huesca, Spain;(15)Hospital Clínico Universitario de Santiago, Gastroenterology, Santiago de Compostela, Spain;(16)Hospital Santa Creu i Sant Pau, Gastroenterology, Barcelona, Spain;(17)Hospital Universitario de La Princesa- Instituto de Investigación Sanitaria Princesa IIS-IP- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas CIBERehd, Gastroenterology, Madrid, Spain;(18)Hospital Universitario Donostia, Gastroenterology, Donostia, Spain;(19)Hospital Universitario de Burgos, Gastroenterology, Burgos, Spain;(20)Hospital Clínico Universitario Lozano Blesa, Gastroenterology, Zaragoza, Spain;(21)Hospital General Universitario de Alicante, Gastroenterology, Alicante, Spain;(22)Complejo Asistencial Universitario de León, Gastroenterology, León, Spain;(23)Complejo Hospitalario de Navarra, Gastroenterology, Pamplona, Spain;(24)Hospital General Universitari de Castelló, Gastroenterology, Castelló, Spain;(25)Hospital Universitario Virgen Macarena, Gastroenterology, Sevilla, Spain;(26)Hospital Universitari Girona Dr. Josep Trueta, Gastroenterology, Girona, Spain;(27)Hospital General de Tomelloso, Gastroenterology, Tomelloso, Spain;(28)Complejo Hospitalario Universitario de Canarias, Gastroenterology, San Cristóbal de La Laguna, Spain;(29)Hospital Universitario de Fuenlabrada, Gastroenterology, Fuenlabrada, Spain;(30)Hospital General Universitario Gregorio Marañón, Gastroenterology, Madrid, Spain;(31)Hospital Clínico Universitario de Valladolid, Gastroenterology, Valladolid, Spain;(32)Complejo Hospitalario Universitario de Pontevedra, Gastroenterology, Pontevedra, Spain;(33)Complexo Hospitalario Universitario de Ourense, Gastroenterology, Ourense, Spain;(34)Hospital Universitario Infanta Leonor, Gastroenterology, Madrid, Spain;(35)Hospital Universitario Infanta Sofía, Gastroenterology, San Sebastián de los Reyes, Spain;(36)Hospital General La Mancha Centro, Gastroenterology, Alcázar de San Juan, Spain;(37)Hospital General de Granollers, Gastroenterology, Granollers, Spain; on behalf of the ECUFIT study group from the ENEIDA registry
Background
Crohn’s disease (CD) can develop fistulizing complications at any time during the disease course. Enterocutaneous fistulas (ECF) are disabling lesions with a significant impact on quality of life. The aim of this study was to describe the characteristics and natural history of ECF complicating CD, and to analyze its medical and/or surgical management.
Methods
A retrospective analysis of all adult patients with fistulizing CD with at least one episode of ECF from the ENEIDA registry (over 68,000 patients) was performed. ECF were defined as a communication between the gastrointestinal tract and the skin producing leakage of luminal contents. Additional data describing the ECF and its medical or surgical management were gathered. The main endpoint was any ECF-related surgical intervention. Fistula closure was defined as the absence of drainage, with no new abscess or surgery for at least 6 months. A comparison of the characteristics and outcomes after the availability of biologic agents (Jan/2000) was also performed. The baseline characteristics were analyzed by means of descriptive statistics and were compared by non-parametric tests. Factors associated with surgery were further evaluated in a binary multivariable regression and survival analysis.
Results
A total of 301 ECF in 286 patients from 46 hospitals diagnosed between Jan/1970-Sept/2020 were included (median age 34 years (IQR, 27-46); 59% male; 67% L3). ECF had a median of 1 external opening (range 1-10), 59% with concomitant internal fistulas, and usually involved the ileum (67%) or colon (23%). After 146 months (IQR, 69-233) of follow-up, 37% received thiopurines, 40% anti-TNF, 6% ustekinumab and 2% vedolizumab. Surgery was performed in 208 patients (69%) after a median of 4 months (IQR, 1.4-12). Fistula closure was achieved in 253 patients (84%) after 30 months (IQR, 4-84), mostly after surgery (54%) and in one third after medical therapy. Fistula recurrence was uncommon (11%) after closure.
Patient and fistula characteristics were significantly different after the availability of biologics. In fact, anti-TNF biologics and thiopurines reduced surgery risk (HR 0.5; 0.38-0.67; HR 0.64; 0.47-0.86, respectively). The surgery rate in the biologic era tends to be lower than before (OR 0.63;0.33-1.09) while timing is similar. Closure rates are also comparable, but it was obtained more frequently after medical therapy once biologicals were available (OR 2.21; 1.13-4.29).
Conclusion
ECF complicating CD entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A number of patients can benefit from medical therapy and achieve fistula closure.