Clinical Outcome After Entero-Enteric Anastomosis for Crohn's Disease: A Case-Control Study.

Background and aims: The outcome of Crohn's Disease (CD) patients with entero-enteric anastomosis (EEA) after small bowel resection is undefined. The primary aim of the present case-control study was to compare the clinical recurrence rate within the first 5 years after surgery in CD patients with small bowel EEA (Cases) versus age-matched patients with ileo-colonic anastomosis (ICA, Controls).

Methods: All CD patients with EEA were matched for age at diagnosis (±5years) and smoking habits with 2 Controls with ICA. Inclusion criteria: 1)age ≥ 18; 2)EEA or ICA for CD; 3)≥5-years follow-up after surgery. Exclusion criteria: 1) missing data; 2)ostomy; 3)stricturoplasty.

Results: The study population included 51CD patients with EEA and 102 matched Controls with ICA. During the first 5 years after surgery, clinical recurrence and CD-related hospitalizations were more frequent in Cases (34 [66.7%] vs. 43 [42.2%], p = 0.007; 25 [49%] vs. 23 [22.5%], p = 0.001). During the same period, corticosteroids, immunosuppressors and biologics use were also more frequent in Cases (26 [50.9%] vs. 18 [17.6%], p < 0.0001; 21 [41.2%] vs. 24 [23.5%], p = 0.03; 23 [45.1%] vs. 15 [14.7%], p = 0.03). Survival time from clinical recurrence and hospitalization was shorter in Cases (2.36 [1.29-4.35], p = 0.003; 1.71 [1.06-2.77], p = 0.02).EEA and immunosuppressors use before surgery were risk factors for clinical recurrence and CD-related hospitalization at 5 years (2.68 [1.11-6.45], p = 0.02; 2.61 [1.21-5.6], p = 0.01; 2.53 [1.05-6.09], p = 0.03; 2.44 [1.18-5], p = 0.01).

Conclusions: The clinical outcome is more severe in CD patients with EEA than in those with ICA, being associated with a higher rate of clinical recurrence and hospitalization after surgery.