Management and Long-term Outcomes of Crohn’s Disease Complicated with Enterocutaneous Fistula: ECUFIT Study from GETECCU

• Published in: Journal of Crohn's and colitis Vol. 16; no. 7; pp. 1049 - 1058
• Main Authors: Barreiro-de Acosta, Manuel, Riestra, Sabino, Calafat, Margalida, Soto, María Pilar, Calvo, Marta, Sánchez Rodríguez, Eugenia, Caballol, Berta, Vela, Milagros, Rivero, Montserrat, Muñoz, Fernando, de Castro, Luisa, Calvet, Xavier, García-Alonso, Francisco Javier, Utrilla Fornals, Alejandra, Ferreiro-Iglesias, Rocío, González-Muñoza, Carlos, Chaparro, María, Bujanda, Luis, Sicilia, Beatriz, Alfambra, Erika, Rodríguez, Andrés, Pérez Fernández, Rubén, Rodríguez, Cristina, Almela, Pedro, Argüelles, Federico, Busquets, David, Tamarit-Sebastián, Sonsoles, Reygosa Castro, Cristina, Jiménez, Laura, Marín-Jiménez, Ignacio, Alcaide, Noelia, Fernández-Salgado, Estela, Iglesias, Águeda, Ponferrada, Ángel, Pajares, Ramón, Roncero, Óscar, Morales-Alvarado, Víctor Jair, Ispízua-Madariaga, Nahia, Sáinz, Empar, Merino, Olga, Márquez-Mosquera, Lucía, García-Sepulcre, Mariana, Elorza, Ainara, Estrecha, Sandra, Surís, Gerard, Van Domselaar, Manuel, Brotons, Alicia, de Francisco, Ruth, Cañete, Fiorella, Iglesias, Eva, Vera, María Isabel, Mesonero, Francisco, Lorente, Rufo, Zabana, Yamile, Cabriada, José Luis, Domènech, Eugeni, Rodríguez-Lago, Iago
• Format: Journal Article
• Language: English
• Published: UK Oxford University Press 04.08.2022
• Subjects: enterocutaneous fistula; fistula; Crohn’s disease; surgery
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjac016

Abstract Background and aims Crohn’s disease [CD] can develop penetrating complications at any time during the disease course. Enterocutaneous fistulae [ECF] are disease-related complications with an important impact on quality of life. Our aim was to describe the outcomes of this complication, including its medical and/or surgical management and their temporal trends. The primary endpoint was fistula closure, defined as the absence of drainage, with no new abscess or surgery, over the preceding 6 months. Methods Clinical information from all adult patients with CD and at least one ECF—excluding perianal fistulae—were identified from the prospectively-maintained ENEIDA registry. All additional information regarding treatment for this complication was retrospectively reviewed. Results A total of 301 ECF in 286 patients [January 1970-September 2020] were analysed out of 30 088 records. These lesions were mostly located in the ileum [67%] and they had a median of one external opening [range 1-10]. After a median follow-up of 146 months (interquartile range [IQR], 69-233), 69% of patients underwent surgery. Fistula closure was achieved in 84%, mostly after surgery, and fistula recurrence was uncommon [13%]. Spontaneous and low-output fistulae were associated with higher closure rates (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.17-1.93, p = 0.001, and HR 1.49, 95% CI 1.07-2.06, p = 0.03, respectively); this was obtained more frequently with medical therapy since biologics have been available. Conclusions ECF complicating CD are rare but entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A significant proportion of patients receiving medical therapy can achieve fistula closure.