Initial Management of Intra-abdominal Abscesses and Preventive Strategies for Abscess Recurrence in Penetrating Crohn’s Disease: A National, Multicentre Study Based on ENEIDA Registry

Casas Deza, Diego (Universidad de Zaragoza) ; Polo Cuadro, Cristina ; de Francisco, Ruth ; Vela González, Milagros ; Bermejo, Fernando ; Blanco, Ignacio ; de la Serna, Álvaro ; Bujanda, Luis ; Bernal, Lorena ; Rueda García, José Luis ; Gargallo-Puyuelo, Carla J (Universidad de Zaragoza) ; Fuentes-Valenzuela, Esteban ; Castro, Beatriz ; Guardiola, Jordi ; Ladrón, Gemma ; Suria, Carles ; Sáez Fuster, Julia ; Gisbert, Javier P ; Sicilia, Beatriz ; Gomez, Raquel ; Muñoz Vilafranca, Carmen ; Barreiro-De Acosta, Manuel ; Peña, Elena ; Castillo Pradillo, Marta ; Cerrillo, Elena ; Calvet, Xavier ; Manceñido, Noemí ; Monfort i Miquel, David ; Marín, Sandra ; Roig, Cristina ; Marce, Ainhoa ; Ramírez de Piscina, Patricia ; Betoré, Elena ; Martin-Cardona, Albert ; Teller, Marta ; Alonso Abreu, Inmaculada ; Maroto, Nuria ; Frago, Santiago ; Gardeazabal, Diego ; Pérez-Martínez, Isabel ; Febles González, Ángel David ; Barrero, Sara ; Taxonera, Carlos ; García de la Filia, Irene ; Ezkurra-Altuna, Ander ; Madero, Lucía ; Martín-Arranz, María Dolores ; Gomollón, Fernando (Universidad de Zaragoza) ; Domènech, Eugeni ; García-López, Santiago (Universidad de Zaragoza)

Resumen: Introduction
Intra-abdominal abscesses complicating Crohn’s disease [CD] are a challenging situation. Their management, during hospitalisation and after resolution, is still unclear.
Methods
Adult patients with CD complicated with intra-abdominal abscess. who required hospitalisation, were included from the prospectively maintained ENEIDA registry from GETECCU. Initial strategy effectiveness and safety to resolve abscess was assessed. Survival analysis was performed to evaluate recurrence risk. Predictive factors associated with resolution were evaluated by multivariate regression and predictive factors associated with recurrence were assessed by Cox regression.
Results
In all, 520 patients from 37 Spanish hospitals were included; 322 [63%] were initially treated with antibiotics alone, 128 [26%] with percutaneous drainage, and 54 [17%] with surgical drainage. The size of the abscess was critical to the effectiveness of each treatment. In abscesses < 30 mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50 mm, surgery was superior to percutaneous drainage, although it was associated with a higher complication rate. After abscess resolution, luminal resection was associated with a lower 1-year abscess recurrence risk [HR 0.43, 95% CI 0.24-0.76]. However, those patients who initiated anti-TNF therapy had a similar recurrence risk whether luminal resection had been performed.
Conclusions
Small abscesses [<30mm] can be managed with antibiotics alone; larger ones require drainage. Percutaneous drainage will be effective and safer than surgery in many cases. After discharge, anti-TNF therapy reduces abscess recurrence risk in a similar way to bowel resection.

Idioma: Inglés

DOI: 10.1093/ecco-jcc/jjad184

Año: 2024

Publicado en: Journal of Crohn's & colitis 18, 4 (2024), 578-588
ISSN: 1873-9946

Factor impacto JCR: 8.7 (2024)

Categ. JCR: GASTROENTEROLOGY & HEPATOLOGY rank: 12 / 147 = 0.082 (2024) - Q1 - T1

Factor impacto SCIMAGO: 2.991 - Medicine (miscellaneous) (Q1) - Gastroenterology (Q1)

Financiación: info:eu-repo/grantAgreement/ES/ISCIII-FEDER/CM21-00067

Tipo y forma: Article (Published version)

Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)