Correlation study on mesenteric fat and disease behavior in patients of Crohn's disease / 中华普通外科杂志

Objective:To analyze the relationship between mesenteric fat or creeping fat and bowel stricture or penetrating disease of Crohn's disease (CD).Methods:Clinical data of 101 CD patients undergoing bowel surgery at Department of General Surgery in our hospital between Mar 2021 and Dec 2021 were retrospectively analyzed. The characteristics of mesenteric fat, creeping fat, luminal cross-section diameter, and the intestinal stricture index were analyzed. The Spearman correlation analysis was used to evaluate the correlation between disease behavior and mesenteric fat score or creeping fat score.Results:Totally 101 CD patients were enrolled, with 68 stricturing diseases and 33 penetrating diseases. CD patients with stricturing diseases had higher score of mesenteric disease activity index (4.6±1.9 vs. 3.7±2.0, t=2.212, P=0.029) and creeping fat index (4.2±2.0 vs. 2.9±1.6, t=3.154, P=0.002) than those in patients with penetrating diseases. The mesenteric fat and creeping fat score positively correlated with the intestinal stricture index, C-reactive protein, and fecal calprotectin, and negatively correlated with minimum luminal cross-section diameter. Conclusion:The higher score of mesenteric fat and creeping fat were observed in CD patients with stricturing disease, which were associated with intestinal stricture index and inflammation status.

Risk of surgery in patients with stricturing type of Crohn's disease at the initial diagnosis: a single center experience

BACKGROUND/AIMS: It remains uncertain which patients with stricturing-type Crohn's disease (CD) require early small bowel surgery after the initial diagnosis. We aimed to clarify clinical characteristics associated with the intervention in such condition of CD. METHODS: We retrospectively evaluated the clinical course of 53 patients with CD and small bowel strictures who were initially treated with medications after the initial diagnosis. We investigated possible associations between small bowel surgery and the following: clinical factors and radiologic findings at initial diagnosis and the types of medications administered during follow-up. RESULTS: Twenty-eight patients (53%) required small bowel resection during a median follow-up period of 5.0 years (range, 0.5–14.3 years). The cumulative incidence rates of small bowel surgery at 2, 5, and 10 years were 26.4%, 41.0%, and 63.2%, respectively. Univariate analysis indicated that obstructive symptoms (P=0.036), long-segment stricture (P<0.0001), and prestenotic dilation (P<0.0001) on radiography were associated with small bowel surgery, and immunomodulatory (P=0.037) and biological therapy (P=0.008) were significant factors during follow-up. Multivariate analysis revealed that long-segment stricture (hazard ratio [HR], 4.25; 95% confidence interval [CI], 1.78–10.53; P=0.001) and prestenotic dilation (HR, 3.41; 95% CI, 1.24–9.62; P=0.018) on radiography showed a positive correlation with small bowel surgery, and biological therapy (HR, 0.40; 95% CI, 0.15–0.99; P=0.048) showed a negative correlation. CONCLUSIONS: CD patients with long-segment stricture and prestenotic dilation on radiography seem to be at a higher risk of needing small bowel surgery. For such patients, early surgical intervention might be appropriate, even at initial diagnosis.

Clinical effect of surgical treatment of stricturing Crohn's disease / 中华消化外科杂志

Objective To explore the clinical effect of surgical treatment of stricturing Crohn's disease (CD).Methods The retrospective cross-sectional study was conducted.The clinical data of 28 patients with stricturing CD who were admitted to the First Affiliated Hospital of Zhejiang University School of Medicine between June 2013 and April 2016 were collected.After improving the patients' nutritional status by preoperative corresponding treatment and optimizing the risk factors of complications,patients received individualized therapy according to their conditions.The intestinal one-stage resection and anastomosis or ostomy were performed at the stenotic locus causing sypmtoms,and no treatment or angioplasty for stenosis was performed at the gentle stenotic locus.Patients received regularly postoperative outpatient reexaminations.The medication was used to prevent recurrence according to the individual conditions.Observation indicators:surgical procedures (open or laparoscopic surgery),operation time,volume of intraoperative blood loss,number of patients with intraoperative blood transfusion,length of intestine resected,anastomosis methods,angioplasty for stenosis,duration of postoperative hospital stay,postoperative complications and follow-up.Follow-up using outpatient examination,telephone interview and wechat was performed to detect the abdominal pain,diarrhea,symptoms of clinical recurrence and endoscopic recurrence situations up to July 2016.Results All the 28 patients with stricturing CD underwent the selective operations,including 8 undergoing laparoscopic surgery (3 receiving conversion to open surgery) and 20 undergoing open surgery.Of 28 patients,2 underwent partial upper jejunum resection,10 underwent partial terminal ileum resection,15 underwent right hemicolectomy and 1 underwent colectomy.Operation time and volume of intraoperative blood loss were 33-288 minutes with an average time of 122 minutes and 50-650 mL with an average volume of 200 mL,respectively.One patient had intraoperative blood transfusion.Length of intestine resected of 28 patients was 10-150 cm,with an average of 54 cm and a total length of 1 510 cm.Of 28 patients,26 received the side-to-side anastomosis using linear closures (1 received the end-to-side anastomosis using pipe stapler,1 with multiple lesions and rectovaginal fistula received colectomy and ileostomy).Two patients with multiple stenosis of the small intestine underwent intestinal resection combined with angioplasty for stenosis in 3 loci.Duration of postoperative hospital stay was 7-45 days,with an average duration of 15 days.No patient died of surgery.Three patients had postoperative complications,including wound infection,incisional hernia and anastomotic leakage.Twenty-one patients were followed up for 3 months to 2 years,with a median time of 11 months,and there was no recurrence during the follow-up.Conclusions Surgical treatment should be performed to the patients with non-symptom,chronic and fibrous stricturing CD and anastomotic stenosis after ineffective medical treatment,with a satisfactory outcome.Meanwhile,it need follow the principle of minimally invasive.And optimizing high risk factors of complications before operation is a key point for preventing postoperative complications.