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Surgical management of duodenal crohn’s disease

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Abstract

Background

Operative options for duodenal Crohn’s disease include bypass, stricturoplasty, or resection. What factors are associated with operation selection and whether differences exist in outcomes is unknown.

Methods

Patients with duodenal Crohn’s disease requiring operative intervention across a multi-state health system were identified. Patient and operative characteristics, short-term surgical outcomes, and the need for future endoscopic or surgical management of duodenal Crohn’s disease were analyzed.

Results

40 patients underwent bypass (n = 26), stricturoplasty (n = 8), or resection (n = 6). Median age of diagnosis of Crohn’s disease was 23.5 years, and over half of the patients had undergone prior surgery for CD. Operation type varied by the most proximal extent of duodenal involvement. Patients with proximal duodenal CD underwent bypass operations more commonly than those with mid- or distal duodenal disease (p = 0.03). Patients who underwent duodenal stricturoplasty more often required concomitant operations for other sites of small bowel or colonic CD (63%) compared to those who underwent bypass (39%) or resection (33%). No patients required subsequent surgery for duodenal CD at a median follow-up of 2.8 years, but two patients required endoscopic dilation (n = 1 after stricturoplasty, n = 1 after resection).

Conclusion

Patients who require surgery for duodenal Crohn’s disease appear to have an aggressive Crohn’s disease phenotype, represented by a younger age of diagnosis and a high rate of prior resection for Crohn’s disease. Choice of operation varied by proximal extent of duodenal Crohn’s disease.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

References

  1. Cohen BL (2022) Gastroduodenal and jejunoileal crohn’s disease. Gastroenterol Hepatol (N Y) 18(7):418–421

    PubMed  Google Scholar 

  2. Louis E, Collard A, Oger AF, Degroote E, Aboul Nasr El Yafi FA, Belaiche J (2001) Behaviour of Crohn’s disease according to the Vienna classification: changing pattern over the course of the disease. Gut. 49(6):777–782

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Annunziata ML, Caviglia R, Papparella LG, Cicala M (2012) Upper gastrointestinal involvement of Crohn’s disease: a prospective study on the role of upper endoscopy in the diagnostic work-up. Dig Dis Sci 57(6):1618–1623

    Article  PubMed  Google Scholar 

  4. Greuter T, Piller A, Fournier N et al (2018) Upper gastrointestinal tract involvement in crohn’s disease: frequency, risk factors, and disease course. J Crohns Colitis 12(12):1399–1409

    Article  PubMed  Google Scholar 

  5. Worsey MJ, Hull T, Ryland L, Fazio V (1999) Strictureplasty is an effective option in the operative management of duodenal Crohn’s disease. Dis Colon Rectum 42(5):596–600

    Article  CAS  PubMed  Google Scholar 

  6. Yamamoto T, Bain IM, Connolly AB, Allan RN, Keighley MR (1999) Outcome of strictureplasty for duodenal Crohn’s disease. Br J Surg 86(2):259–262

    Article  CAS  PubMed  Google Scholar 

  7. Murray JJ, Schoetz DJ Jr, Nugent FW, Coller JA, Veidenheimer MC (1984) Surgical management of Crohn’s disease involving the duodenum. Am J Surg 147(1):58–65

    Article  CAS  PubMed  Google Scholar 

  8. Tonelli F, Alemanno G, Bellucci F, Focardi A, Sturiale A, Giudici F (2013) Symptomatic duodenal Crohn’s disease: is strictureplasty the right choice? J Crohns Colitis 7(10):791–796

    Article  PubMed  Google Scholar 

  9. Shapiro M, Greenstein AJ, Byrn J et al (2008) Surgical management and outcomes of patients with duodenal Crohn’s disease. J Am Coll Surg 207(1):36–42

    Article  PubMed  Google Scholar 

  10. Lossing A, Langer B, Jeejeebhoy KN (1983) Gastroduodenal Crohn’s disease: diagnosis and selection of treatment. Can J Surg 26(4):358–360

    CAS  PubMed  Google Scholar 

  11. Lightner AL (2018) Duodenal Crohn’s Disease. Inflamm Bowel Dis 24(3):546–551

    Article  PubMed  Google Scholar 

  12. Kornbluth A (1998) Infliximab approved for use in Crohn’s disease: a report on the FDA GI Advisory Committee conference. Inflamm Bowel Dis 4(4):328–329

    Article  CAS  PubMed  Google Scholar 

  13. Yarur AJ, Strobel SG, Deshpande AR, Abreu MT (2011) Predictors of aggressive inflammatory bowel disease. Gastroenterol Hepatol (N Y) 7(10):652–659

    PubMed  Google Scholar 

  14. McKenna NP, Habermann EB, Glasgow AE, Dozois EJ, Lightner AL (2018) Intra-abdominal sepsis after ileocolic resection in Crohn’s disease: the role of combination immunosuppression. Dis Colon Rectum 61(12):1393–1402

    Article  PubMed  Google Scholar 

  15. Crocco S, Martelossi S, Giurici N, Villanacci V, Ventura A (2012) Upper gastrointestinal involvement in paediatric onset Crohn’s disease: prevalence and clinical implications. J Crohns Colitis 6(1):51–55

    Article  CAS  PubMed  Google Scholar 

  16. Chow DK, Sung JJ, Wu JC, Tsoi KK, Leong RW, Chan FK (2009) Upper gastrointestinal tract phenotype of Crohn’s disease is associated with early surgery and further hospitalization. Inflamm Bowel Dis 15(4):551–557

    Article  PubMed  Google Scholar 

  17. Brennan GT, Ha I, Hogan C et al (2018) Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn’s disease patients: a meta-analysis. Eur J Gastroenterol Hepatol 30(9):997–1002

    Article  PubMed  Google Scholar 

  18. Yamamoto T, Nakahigashi M, Shimoyama T, Umegae S (2020) Does preoperative enteral nutrition reduce the incidence of surgical complications in patients with Crohn’s disease? A case-matched study Colorectal Dis 22(5):554–561

    Article  CAS  PubMed  Google Scholar 

  19. Bettenworth D, Mucke MM, Lopez R et al (2019) Efficacy of endoscopic dilation of gastroduodenal crohn’s disease strictures: a systematic review and meta-analysis of individual patient data. Clin Gastroenterol Hepatol. 17(12):2514-2522 e2518

    Article  PubMed  Google Scholar 

  20. Jacobson S (2012) Early postoperative complications in patients with Crohn’s disease given and not given preoperative total parenteral nutrition. Scand J Gastroenterol 47(2):170–177

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, 200 1St Street SW, Rochester, MN, 55905, USA

    Nicholas P. McKenna, Franciso M. Abarca Rendon, Asya Ofshteyn, Thomas Peponis, Sherief F. Shawki, Scott R. Kelley & Kellie L. Mathis

  2. The Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Katherine A. Bews

  3. Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Maxwell D. Mirande

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  1. Nicholas P. McKenna
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Contributions

Nicholas McKenna—(1) the conception and design of the study, acquisition of data, analysis, and interpretation of data, (2) drafting the article, and (3) final approval of the version to be submitted.

Katherine Bews—(1) acquisition of data, analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Maxwell Mirande—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Franciso Abarca Rendon—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Asya Ofshteyn—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Thomas Peponis—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Sherief Shawki—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Scott Kelley—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Kellie Mathis—(1) analysis and interpretation of data, (2) revising it critically for important intellectual content, (3) final approval of the version to be submitted.

Corresponding author

Correspondence to Nicholas P. McKenna.

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Presentation

This manuscript was presented as a podium presentation in the Inflammatory Bowel Disease abstract session at the 2023 American Society of Colon and Rectal Surgeons Annual Meeting in Seattle, Washington from June 3-6, 2023.

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McKenna, N.P., Bews, K.A., Mirande, M.D. et al. Surgical management of duodenal crohn’s disease. Langenbecks Arch Surg 409, 132 (2024). https://doi.org/10.1007/s00423-024-03324-w

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