DDW ePoster Library

POST-OPERATIVE PHARMACOLOGICAL THERAPIES FOR THE PREVENTION OF SURGICAL RECURRENCE IN CHILDREN WITH CROHN'S DISEASE: A SYSTEMATIC REVIEW
DDW ePoster Library. Banegas M. 05/21/22; 354400; Sa1643
Dr. Marcela Banegas
Dr. Marcela Banegas
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Number: Sa1643
POST-OPERATIVE PHARMACOLOGICAL THERAPIES FOR THE PREVENTION OF SURGICAL RECURRENCE IN CHILDREN WITH CROHN'S DISEASE: A SYSTEMATIC REVIEW

Society: AGA
Track: Inflammatory Bowel Diseases

Author(s): Marcela Banegas1, 2, 3, Carolina Vigna4, Sarah Towner Wright5, Jocelyn Anne Silvester1, 3, Matthew D. Egberg6

Institution(s): 1. Celiac Disease Research Program, Harvard Medical School, Boston, MA, United States. 2. Celiac Center, Beth Israel Deaconess Medical Center, Boston, MA, United States. 3. Boston Children's Hospital, Boston, MA, United States. 4. Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States. 5. UNC Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. 6. Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Background: Children with Crohn's Disease (CD) frequently require surgical intervention, with multiple surgeries often needed. We conducted a systematic review to evaluate the effectiveness of post-operative pharmacologic therapies to prevent second intestinal resection in children with CD.

Methods: Studies of children (‰¤18 years) with CD undergoing post-pyloric intestinal resection published between January 1998 and July 2021 indexed in PubMed, EMBASE, Cochrane, Web of Science or EBSCO were systematically reviewed. Included studies reported: initial surgery, post-operative surgical recurrence, and post-operative pharmacologic exposures. Index surgeries involving strictureplasty, appendectomy, fistulotomy and/or ostomy creation/take down were excluded. Conference abstracts, reviews, meta-analyses, case reports/series, and unpublished reports were also excluded.

Results: A total of 8,765 records were identified yielding 3,077 unique citations upon removal of duplicates. After full-text review of 211 citations, 9 studies met all inclusion criteria; outcomes were available for 580 children. The overall risk of surgical recurrence was 24% (139/580). Only 5 studies reported surgical recurrence stratified by post-operative treatment in children with CD. Surgical recurrence for children receiving anti-TNF monotherapy was reported in 4/5 studies (n=60) whereas children receiving non-anti-TNF therapy was reported in all 5 studies(n=194). Non-anti-TNF therapies in these studies included: 5-ASA, mesalamine, thiopurines, no treatment, and non-anti-TNF non-specified treatments. The surgical recurrence rate among children receiving anti-TNF monotherapy was 18% (95% CI, 9.9-30.8) while the non-anti-TNF group was 22% (95% CI, 16.7-28.8) (Table 1,2).


Conclusion: A considerable proportion (24%) of children with CD have surgical recurrence following initial resection for CD management even in the biologic era. The observed rates of surgical recurrence were similar in those who received anti-TNF monotherapy (18%) and those who did not (22%). More rigorous prospective studies are needed to better understand the role of anti-TNF and other medications in post-operative prophylaxis and post-operative treatment to prevent surgical recurrence in children with CD.
Number: Sa1643
POST-OPERATIVE PHARMACOLOGICAL THERAPIES FOR THE PREVENTION OF SURGICAL RECURRENCE IN CHILDREN WITH CROHN'S DISEASE: A SYSTEMATIC REVIEW

Society: AGA
Track: Inflammatory Bowel Diseases

Author(s): Marcela Banegas1, 2, 3, Carolina Vigna4, Sarah Towner Wright5, Jocelyn Anne Silvester1, 3, Matthew D. Egberg6

Institution(s): 1. Celiac Disease Research Program, Harvard Medical School, Boston, MA, United States. 2. Celiac Center, Beth Israel Deaconess Medical Center, Boston, MA, United States. 3. Boston Children's Hospital, Boston, MA, United States. 4. Division of Colorectal Surgery, Beth Israel Deaconess Medical Center, Boston, MA, United States. 5. UNC Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States. 6. Department of Pediatrics, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.

Background: Children with Crohn's Disease (CD) frequently require surgical intervention, with multiple surgeries often needed. We conducted a systematic review to evaluate the effectiveness of post-operative pharmacologic therapies to prevent second intestinal resection in children with CD.

Methods: Studies of children (‰¤18 years) with CD undergoing post-pyloric intestinal resection published between January 1998 and July 2021 indexed in PubMed, EMBASE, Cochrane, Web of Science or EBSCO were systematically reviewed. Included studies reported: initial surgery, post-operative surgical recurrence, and post-operative pharmacologic exposures. Index surgeries involving strictureplasty, appendectomy, fistulotomy and/or ostomy creation/take down were excluded. Conference abstracts, reviews, meta-analyses, case reports/series, and unpublished reports were also excluded.

Results: A total of 8,765 records were identified yielding 3,077 unique citations upon removal of duplicates. After full-text review of 211 citations, 9 studies met all inclusion criteria; outcomes were available for 580 children. The overall risk of surgical recurrence was 24% (139/580). Only 5 studies reported surgical recurrence stratified by post-operative treatment in children with CD. Surgical recurrence for children receiving anti-TNF monotherapy was reported in 4/5 studies (n=60) whereas children receiving non-anti-TNF therapy was reported in all 5 studies(n=194). Non-anti-TNF therapies in these studies included: 5-ASA, mesalamine, thiopurines, no treatment, and non-anti-TNF non-specified treatments. The surgical recurrence rate among children receiving anti-TNF monotherapy was 18% (95% CI, 9.9-30.8) while the non-anti-TNF group was 22% (95% CI, 16.7-28.8) (Table 1,2).


Conclusion: A considerable proportion (24%) of children with CD have surgical recurrence following initial resection for CD management even in the biologic era. The observed rates of surgical recurrence were similar in those who received anti-TNF monotherapy (18%) and those who did not (22%). More rigorous prospective studies are needed to better understand the role of anti-TNF and other medications in post-operative prophylaxis and post-operative treatment to prevent surgical recurrence in children with CD.

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