Meta-analysis of early bowel resection versus initial medical therapy in patient's with ileocolonic Crohn's disease.

Ryan, Éanna J.; Orsi, Gabriel; Boland, Michael R.; Syed, Adeel Zafar; Creavin, Ben; Kelly, Michael E.; Sheahan, Kieran; Neary, Paul C.; Kavanagh, Dara O.; McNamara, Deirdre; Winter, Des C.; O'Riordan, James M.

Background: Early bowel resection (EBR) in ileocolonic Crohn's disease (CD) may be associated with more durable remission compared with initial medical therapy (IMT) even when biologic therapy is included. Aim: To compare the efficacy of EBR versus IMT for ileocolonic CD Methods: A systematic search was performed to identify studies that compared EBR (performed < 1 year from initial diagnosis) or IMT for the management of ileocolonic CD. Log hazard ratios (InHR) for relapse-free survival (RFS) and their standard errors were calculated from Kaplan-Meier plots and pooled using the inverse-variance method. Dichotomous variables were pooled as odds ratios (OR). Quality assessment of the included studies was performed using the Newcastle-Ottawa (NOS) and Jadad scales. Results: A total of 7 studies with 1863 CD patients (EBR n = 581, 31.2%; IMT n = 1282, 68.8%) were eligible for inclusion. There was a moderate-to-high risk of bias. The median NOS was 8 (range 7–9). There was a reduced likelihood of overall (OR, 0.53; 95% confidence interval (95% CI), 0.34, 0.83; p = 0.005) and surgical (OR, 0.47; 95% CI, 0.24, 0.91; p = 0.03) relapse with EBR. There was also a less requirement for maintenance biologic therapy (OR, 0.24; 95% CI, 0.14, 0.42; p < 0.0001). Patients who underwent EBR had a significantly improved RFS than those who underwent IMT (HR, 0.62; 95% CI, 0.52, 0.73; p < 0.001). There was no difference in morbidity (OR, 1.67; 95% CI, 0.44, 6.36; p = 0.45) between the groups. Conclusion: EBR may be associated with less relapse and need for maintenance biologic therapy than IMT. 'Upfront' or early resection may represent a reasonable and cost-effective alternative to biologic therapy, especially in biologic-resistant subpopulations. Trial registration:

NEWCASTLE upon Tyne (England); CROHN'S disease; BIOTHERAPY; INFLAMMATORY bowel diseases; META-analysis; ANAL diseases; DISEASE remission

International Journal of Colorectal Disease, 2020, Vol 35, Issue 3, p501

0179-1958

Academic Journal

10.1007/s00384-019-03479-9