Department of Internal Medicine, University of California San Diego, La Jolla, CA, USA.
Division of Gastroenterology, Department of Medicine, University of California San Diego, La Jolla, CA, USA.
J Crohns Colitis. 2024 Mar 1;18(3):375-391. doi: 10.1093/ecco-jcc/jjad159.
We evaluated short- and long-term outcomes of temporary faecal diversion [FD] for management of refractory Crohn's disease [CD], focusing on outcomes in the biologic era.
Through a systematic literature review until March 15, 2023, we identified 33 studies [19 conducted in the biologic era] that evaluated 1578 patients with perianal and/or distal colonic CD who underwent temporary FD [with intent of restoring bowel continuity] and reported long-term outcomes [primary outcome: successful restoration of bowel continuity, defined as remaining ostomy-free after reconnection at a minimum of 6 months after diversion or at the end of follow-up]. We calculated pooled rates (with 95% confidence interval [CI]) using random effects meta-analysis, and examined factors associated with successful restoration of bowel continuity.
Overall, 61% patients [95% CI, 52-68%; 50% in biologic era] experienced clinical improvement after FD. Stoma takedown was attempted in 34% patients [28-41%; 37% in biologic era], 6-18 months after diversion. Among patients where bowel restoration was attempted, 63% patients [54-71%] had successful restoration of bowel continuity, and 26% [20-34%] required re-diversion. Overall, 21% patients [17-27%; 24% in biologic era] who underwent FD were successfully restored; 34% patients [30-39%; 31% in biologic era] required proctectomy with permanent ostomy. On meta-regression, post-diversion biologic use and absence of proctitis was associated with successful bowel restoration after temporary FD in contemporary studies.
In the biologic era, temporary FD for refractory perianal and/or distal colonic CD improves symptoms in half the patients, and bowel continuity can be successfully restored in a quarter of patients.
我们评估了临时粪便转流[FD]治疗难治性克罗恩病[CD]的短期和长期结果，重点关注生物制剂时代的结果。
通过系统文献回顾，截至 2023 年 3 月 15 日，我们共确定了 33 项研究[19 项在生物制剂时代进行]，评估了 1578 例患有肛周和/或远端结肠 CD 的患者，他们接受了临时 FD[意图恢复肠连续性]并报告了长期结果[主要结局：成功恢复肠连续性，定义为在分流后至少 6 个月或在随访结束时保持无造口]。我们使用随机效应荟萃分析计算了汇总率（95%置信区间[CI]），并检查了与成功恢复肠连续性相关的因素。
总体而言，61%的患者[95%CI，52-68%；生物制剂时代为 50%]在 FD 后临床症状得到改善。34%的患者[28-41%；生物制剂时代为 37%]尝试在分流后 6-18 个月行造口关闭术。在尝试肠重建的患者中，63%的患者[54-71%]成功恢复肠连续性，26%的患者[20-34%]需要再次分流。总体而言，21%的患者[17-27%；生物制剂时代为 24%]通过 FD 成功恢复；34%的患者[30-39%；生物制剂时代为 31%]需要行直肠切除术并永久性造口。元回归分析显示，分流后使用生物制剂和无直肠炎与当代研究中临时 FD 后成功恢复肠连续性相关。
在生物制剂时代，难治性肛周和/或远端结肠 CD 的临时 FD 可改善一半患者的症状，并可成功恢复四分之一患者的肠连续性。
