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Dourado J, Wignakumar A, Emile SH, Rogers P, Weiss BP, Khan SM, Aeschbacher P, Wexner SD. Bypass is associated with lower treatment failure than stricturoplasty in duodenal Crohn's disease: a systematic review with pairwise and network meta-analyses. J Gastrointest Surg 2025; 29:102041. [PMID: 40154834 DOI: 10.1016/j.gassur.2025.102041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2025] [Revised: 03/14/2025] [Accepted: 03/22/2025] [Indexed: 04/01/2025]
Abstract
BACKGROUND Crohn's disease (CD) of the duodenum is uncommon, and the goal of treatment is often avoidance of surgery. However, as many as one-third of patients with CD will eventually require surgery for their disease. This study aimed to compare the outcomes and safety of surgical treatments of duodenal CD. METHODS In this meta-analysis, a search was conducted for studies that reported outcomes of surgical treatment of duodenal CD. The primary outcome was treatment failure. The secondary outcomes were postoperative complications and reoperation rate. RESULTS A total of 10 studies that included 325 patients with predominately stricturing duodenal CD published between 1970 and 2023 were included. Bypass was the surgical treatment for 155 patients (68.6%), followed by stricturoplasty (21.7%) and resection (8.4%). Pairwise meta-analyses revealed that the only significant finding was a lower rate of treatment failure in favor of bypass compared with stricturoplasty (odds ratio [OR], 0.41 [95% CI, 0.18-0.95]; P =.038), with similar odds of complications and reoperation among the 3 operations. In the network meta-analysis, bypass ranked the best with the lowest failure, complication, and reoperation rates. Stricturoplasty had a significantly higher rate of failure than bypass (OR, 2.51 [95% CI, 1.10-5.27]; P =.028). CONCLUSION Among the 3 procedures, surgical bypass ranked the best with the lowest failure, complications, and reoperation rates. Although bypass was associated with a lower failure rate than stricturoplasty, both procedures were associated with similar complication and reoperation rates. Based upon this review, surgical bypass is a safe and effective option for the treatment of stricturing duodenal CD.
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Affiliation(s)
- Justin Dourado
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Anjelli Wignakumar
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, United States; Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt
| | - Peter Rogers
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Brett P Weiss
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, United States
| | - Sualeh Muslim Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Pauline Aeschbacher
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL, United States.
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Klemm NK, Feuerstein JD. A practical guide to dilating inflammatory bowel disease strictures. Expert Rev Gastroenterol Hepatol 2025; 19:377-387. [PMID: 39987913 DOI: 10.1080/17474124.2025.2471873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2024] [Revised: 02/13/2025] [Accepted: 02/21/2025] [Indexed: 02/25/2025]
Abstract
INTRODUCTION Stricturing Crohn's disease is a common phenotype and treatment aims to improve symptoms, prevent complications, assess for proximal bowel disease activity, and screen for upstream neoplasm. Management is challenging due to diagnostic limitations, stricture composition, and recurrence rate. AREAS COVERED Categorizing a stricture as inflammatory or fibrotic is necessary to determine appropriate management. Inflammatory strictures are treated with medical therapy, and fibrostenotic strictures require endoscopic or surgical management. While EBD is increasingly utilized, stricture recurrence rates remain high, necessitating repeat endoscopic procedures or surgery. We performed a PubMed (MEDLINE database) search for the latest research on IBD-related stricture management, including detection, diagnosis, and medical and procedural therapies. We highlight the current literature on endoscopic techniques for the treatment of intestinal strictures and future areas of research. EXPERT OPINION The field of intestinal stricture management is expected to evolve in the coming years and will include enhanced imaging modalities, medication optimization, and increasing use of advanced endoscopic techniques.
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Affiliation(s)
- Natasha K Klemm
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Joseph D Feuerstein
- Division of Gastroenterology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Amadu M, Soldera J. Duodenal Crohn's disease: Case report and systematic review. World J Methodol 2024; 14:88619. [PMID: 38577197 PMCID: PMC10989410 DOI: 10.5662/wjm.v14.i1.88619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/16/2023] [Accepted: 01/18/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Inflammatory bowel disease, including ulcerative colitis, microscopic colitis, and Crohn's disease (CD), has a global impact. This review focuses on duodenal CD (DCD), a rare subtype affecting the duodenum. DCD's rarity and asymptomatic nature create diagnostic challenges, impacting prognosis and patient well-being. Delayed diagnosis can worsen DCD outcomes. AIM To report a rare case of DCD and to discuss the diagnostic challenges and its implications on prognosis. METHODS A systematic literature search, following the PRISMA statement, was conducted. Relevant studies were identified and analysed using specific Medical Subject Terms (MeSH) from PubMed/MEDLINE, American Journal of Gastroenterology, and the University of South Wales database. Data collection included information from radiology scans, endoscopy procedures, biopsies, and histopathology results. RESULTS The review considered 8 case reports and 1 observational study, involving 44 participants diagnosed with DCD, some of whom developed complications due to delayed diagnosis. Various diagnostic methods were employed, as there is no gold standard workup for DCD. Radiology scans [magnetic resonance imaging (MRI), computed tomography (CT), and upper gastrointestinal X-ray], endoscopy procedures (colonoscopy and esophagogastroduodenoscopy), biopsies, and clinical suspicions were utilized. CONCLUSION This review discusses DCD diagnosis challenges and the roles of CT, MRI, and fluoroscopy. It notes their limitations and compares findings with endoscopy and histopathology studies. Further research is needed to improve diagnosis, emphasizing scan interpretation, endoscopy procedures, and biopsies, especially in high-risk patients during routine endoscopy.
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Affiliation(s)
- Muniratu Amadu
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
| | - Jonathan Soldera
- Department of Gastroenterology, University of South Wales, Cardiff CF37 1DL, United Kingdom
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Yang LC, Wu GT, Wu Q, Peng LX, Zhang YW, Yao BJ, Liu GL, Yuan LW. Surgical management of duodenal Crohn's disease. World J Gastrointest Surg 2023; 15:1159-1168. [PMID: 37405094 PMCID: PMC10315127 DOI: 10.4240/wjgs.v15.i6.1159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/24/2023] [Accepted: 04/28/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The case of Crohn's disease involving the duodenum is rare, and its surgical management requires a thorough understanding.
AIM To investigate the surgical management of duodenal Crohn’s disease.
METHODS We systematically reviewed patients diagnosed with duodenal Crohn's disease who underwent surgery in the Department of Geriatrics Surgery of the Second Xiangya Hospital of Central South University from January 1, 2004, to August 31, 2022. The general information, surgical procedures, prognosis, and other information of these patients were collected and summarized.
RESULTS A total of 16 patients were diagnosed with duodenal Crohn’s disease, where 6 cases had primary duodenal Crohn’s disease, and 10 had secondary duodenal Crohn’s disease. Among patients with primary disease, 5 underwent duodenal bypass and gastrojejunostomy, and 1 received pancreaticoduodenectomy. Among those with a secondary disease, 6 underwent closure of duodenal defect and colectomy, 3 received duodenal lesion exclusion and right hemicolectomy, and 1 underwent duodenal lesion exclusion and double-lumen ileostomy.
CONCLUSION Crohn's disease involving the duodenum is a rare condition. Different surgical management should be applied for patients with Crohn's disease presenting with different clinical manifestations.
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Affiliation(s)
- Li-Chao Yang
- Department of Geriatric Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Guo-Tao Wu
- Department of General Surgery, The Seventh Affiliated Hospital, University of South China, Changsha 410119, Hunan Province, China
| | - Qiang Wu
- Department of Geriatric Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Liang-Xin Peng
- Department of Geriatric Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Ya-Wei Zhang
- Department of Geriatric Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Bao-Jia Yao
- Department of Geriatric Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Gang-Lei Liu
- Department of Geriatric Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
| | - Lian-Wen Yuan
- Department of Geriatric Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
- Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha 410011, Hunan Province, China
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Banter LR, Maatman TK, McGuire SP, Ceppa EP, House MG, Nakeeb A, Nguyen TK, Schmidt CM, Zyromski NJ. Duodenal complications in necrotizing pancreatitis: Challenges of an overlooked complication. Am J Surg 2020; 221:589-593. [PMID: 33218676 DOI: 10.1016/j.amjsurg.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 11/02/2020] [Accepted: 11/09/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Duodenal complications of necrotizing pancreatitis (NP) are challenging and understudied. We sought to characterize the demographics and clinical course of NP patients with duodenal complications. METHODS Single institution retrospective review of 687 NP patients treated from 2005 to 2018. RESULTS Duodenal complications developed in 40 (6%) patients including fistula in 11 (2%) and stricture in 29 (4%) patients. Patients with duodenal complications had increased computed tomography severity index (CTSI), degree of glandular necrosis, organ failure, infected necrosis, and disease duration. Mortality from NP was increased in patients with duodenal fistula (36%) compared to patients with duodenal stricture (7%) and patients without duodenal complications (9%). Surgical management of duodenal complications was required in 9/11 (82%) patients with fistula and 17/29 (59%) patients with stricture. CONCLUSIONS Duodenal complications occurred in 6% of necrotizing pancreatitis patients. Sixty five percent of patients with duodenal complications required surgical correction. Duodenal fistula was associated with increased mortality.
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Affiliation(s)
- Lucas R Banter
- Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Thomas K Maatman
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sean P McGuire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Eugene P Ceppa
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Michael G House
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Attila Nakeeb
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Trang K Nguyen
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - C Max Schmidt
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nicholas J Zyromski
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Moon JS, Lee JL, Yu CS, Lim SB, Park IJ, Yoon YS, Kim CW, Yang SK, Ye BD, Park SH, Alsaleem HA, Kim JC. Clinical Characteristics and Postoperative Outcomes of Patients Presenting With Upper Gastrointestinal Tract Crohn Disease. Ann Coloproctol 2020; 36:243-248. [PMID: 32178500 PMCID: PMC7508485 DOI: 10.3393/ac.2019.10.16.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Upper gastrointestinal (GI) tract involvement in Crohn disease (CD) is rare and effectiveness of surgical treatment is limited. The aim of this study was to evaluate characteristics and surgical outcomes of upper GI CD. METHODS Medical records of 811 patients who underwent intestinal surgery for CD between January 2006 and December 2015 at a single institution were reviewed. Upper GI CD was defined by involvement of the stomach to the fourth portion of duodenum, with or without concomitant small/large bowel CD involvement according to a modification of the Montreal classification. RESULTS We identified 24 patients (21 males, 3 females) who underwent surgery for upper GI CD. The mean age at diagnosis was 27 ± 12 years, the mean age at surgery was 33 ± 11 years, and the mean duration of CD was 73.6 ± 56.6 months. Fifteen patients (62.5%) had history of previous perianal surgery. Ten patients (41.7%) had duodenal or gastric stricture and 14 patients (58.3%) had penetrating fistula; patients with fistula were significantly more likely to develop complications (57.1% vs. 20.0%, P = 0.035). One patient with stricture had surgical recurrence. In seven patients with fistula, fistula was related to previous anastomosis. Patients with fistula had significantly longer hospital stays than those with stricture (16 days vs. 11 days, P = 0.01). CONCLUSION Upper GI CD is rare among CD types (2.96%). In patients with upper GI CD, penetrating fistula was associated with longer hospital stay and more complications.
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Affiliation(s)
- Joon Suk Moon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong Lyul Lee
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Sik Yu
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seok-Byung Lim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - In Ja Park
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sik Yoon
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chan Wook Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Suk-Kyun Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hyoung Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hassan Abdullah Alsaleem
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Jin Cheon Kim
- Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Guimarães LS, Greer MLC, Dillman JR, Fletcher JG. Magnetic Resonance in Crohn’s Disease. Magn Reson Imaging Clin N Am 2020; 28:31-44. [DOI: 10.1016/j.mric.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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