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. 2022 Aug 4;16(7):1049-1058.
doi: 10.1093/ecco-jcc/jjac016.

Management and Long-term Outcomes of Crohn's Disease Complicated with Enterocutaneous Fistula: ECUFIT Study from GETECCU

Manuel Barreiro-de Acosta  1 , Sabino Riestra  2 , Margalida Calafat  3 , María Pilar Soto  4 , Marta Calvo  5 , Eugenia Sánchez Rodríguez  6 , Berta Caballol  7 , Milagros Vela  8 , Montserrat Rivero  9 , Fernando Muñoz  10 , Luisa de Castro  11 , Xavier Calvet  12 , Francisco Javier García-Alonso  13 , Alejandra Utrilla Fornals  14 , Rocío Ferreiro-Iglesias  1 , Carlos González-Muñoza  15 , María Chaparro  16 , Luis Bujanda  17 , Beatriz Sicilia  18 , Erika Alfambra  19 , Andrés Rodríguez  20 , Rubén Pérez Fernández  21 , Cristina Rodríguez  22 , Pedro Almela  23 , Federico Argüelles  24 , David Busquets  25 , Sonsoles Tamarit-Sebastián  26 , Cristina Reygosa Castro  27 , Laura Jiménez  28 , Ignacio Marín-Jiménez  29 , Noelia Alcaide  30 , Estela Fernández-Salgado  31 , Águeda Iglesias  32 , Ángel Ponferrada  33 , Ramón Pajares  34 , Óscar Roncero  35 , Víctor Jair Morales-Alvarado  36 , Nahia Ispízua-Madariaga  37 , Empar Sáinz  38 , Olga Merino  39 , Lucía Márquez-Mosquera  40 , Mariana García-Sepulcre  41 , Ainara Elorza  42 , Sandra Estrecha  43 , Gerard Surís  44 , Manuel Van Domselaar  45 , Alicia Brotons  46 , Ruth de Francisco  2 , Fiorella Cañete  3 , Eva Iglesias  4 , María Isabel Vera  5 , Francisco Mesonero  6 , Rufo Lorente  47 , Yamile Zabana  48 , José Luis Cabriada  42 , Eugeni Domènech  3 , Iago Rodríguez-Lago  42
Affiliations

Management and Long-term Outcomes of Crohn's Disease Complicated with Enterocutaneous Fistula: ECUFIT Study from GETECCU

Manuel Barreiro-de Acosta et al. J Crohns Colitis. .

Abstract

Background and aims: Crohn's disease [CD] can develop penetrating complications at any time during the disease course. Enterocutaneous fistulae [ECF] are disease-related complications with an important impact on quality of life. Our aim was to describe the outcomes of this complication, including its medical and/or surgical management and their temporal trends. The primary endpoint was fistula closure, defined as the absence of drainage, with no new abscess or surgery, over the preceding 6 months.

Methods: Clinical information from all adult patients with CD and at least one ECF-excluding perianal fistulae-were identified from the prospectively-maintained ENEIDA registry. All additional information regarding treatment for this complication was retrospectively reviewed.

Results: A total of 301 ECF in 286 patients [January 1970-September 2020] were analysed out of 30 088 records. These lesions were mostly located in the ileum [67%] and they had a median of one external opening [range 1-10]. After a median follow-up of 146 months (interquartile range [IQR], 69-233), 69% of patients underwent surgery. Fistula closure was achieved in 84%, mostly after surgery, and fistula recurrence was uncommon [13%]. Spontaneous and low-output fistulae were associated with higher closure rates (hazard ratio [HR] 1.51, 95% confidence interval [CI] 1.17-1.93, p = 0.001, and HR 1.49, 95% CI 1.07-2.06, p = 0.03, respectively); this was obtained more frequently with medical therapy since biologics have been available.

Conclusions: ECF complicating CD are rare but entail a high burden of medical and surgical resources. Closure rates are high, usually after surgery, and fistula recurrence is uncommon. A significant proportion of patients receiving medical therapy can achieve fistula closure.

Keywords: Crohn’s disease; enterocutaneous fistula; fistula; surgery.

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