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Multicenter Study
. 2025 May 7;9(3):zraf010.
doi: 10.1093/bjsopen/zraf010.

Outcomes of intended temporary stomas in Crohn's disease (INTESTINE study): international, multicentre, retrospective study

Claire Perrott  1 , Giacomo Calini  2   3   4 , Alice Gori  3   4 , Matteo Rottoli  3   4 , Maria E Flacco  5 , Lamberto Manzoli  4 , Zoe Garoufalia  6 , Steven D Wexner  6 , Christos Kontovounisios  1   7   8   9 , Muhammed Elhadi  10 , Valerio Celentano  1   9 ; INTESTINE Study Group
Collaborators, Affiliations
Multicenter Study

Outcomes of intended temporary stomas in Crohn's disease (INTESTINE study): international, multicentre, retrospective study

Claire Perrott et al. BJS Open. .

Abstract

Background: Patients with ileocolic Crohn's disease often require surgery that can result in temporary stoma formation. Stomas are associated with a morbidity and can negatively impact quality of life. This study aimed to investigate the short-term (6-month) and mid-term (18-month) outcomes of intended temporary stomas in patients with Crohn's disease.

Methods: A trainee-led, international multicentre, retrospective study was conducted on all patients who underwent surgery for Crohn's disease in collaborating centres over 4 years (2017-2020). The primary outcome was the proportion of patients with Crohn's disease who underwent stoma reversal surgery by 6- and 18-month postoperative follow-up. Secondary outcomes included: the time interval between formation and reversal of stoma and predictors for non-reversal and stoma-related morbidity (postoperative complications, related readmissions and complications due to stoma reversal surgery).

Results: A total of 401 patients underwent stoma formation for Crohn's disease over the 4 years across the 44 collaborating centres. The temporary stomas had been reversed in 30.2% of patients at the 6-month and 56.9% at the 18-month follow-up. Reasons for non-reversal included ongoing medical treatment for Crohn's disease (respectively 6-month and 18-month: 37.6%, 39.3%), patient unfit for surgery (respectively 6-month and 18-month: 14.5%, 16.8%), patient preference (respectively 6-month and 18-month: 12.1%, 20.2%) and due to waiting lists (respectively 6-month and 18-month: 12.1%, 8.1%). Overall, 63.3% of patients had a temporary stoma reversed with a median time interval of 6 months. The stoma-related overall morbidity rate was 29.4%.

Conclusions: A large proportion of temporary stomas for Crohn's disease were not reversed at 6 and 18 months following initial surgery. Patients are exposed to the risk of non-reversal and risk of developing stoma complications for significantly longer intervals of time and, in some cases, indefinitely.

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Figures

Fig. 1
Fig. 1
Time-to-event analysis between stoma formation and reversal in patients with Crohn’s disease (CD) All locations also includes colon, rectal and perianal CD locations.
Fig. 2
Fig. 2
Time-to-event analysis between stoma formation and reversal in patients with colon, rectal and perianal Crohn’s disease (CD) locations compared with ileal bowel location
Fig. 3
Fig. 3
Time-to-event analysis between stoma formation and reversal in patients with Crohn’s disease (CD) according to the COVID-19 pandemic Pre-COVID includes patients with CD who underwent stoma formation before October 2019. The post-COVID group included October 2019 and the following months.
See this image and copyright information in PMC

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