P197 Retrospective Analysis of Enterocutaneous Fistula Management in IBD
M. Boyle*, G. Doherty, G. Cullen
St Vincents University Hospital, Gastroenterology, Dublin, Ireland
One third of patients with Crohn's disease develop at least one fistula episode during the course of their disease. 6% of these fistulas are enterocutaneous fistulas (ECF).
The objectives of this study was to describe the characteristics, management and outcomes of disease-related ECFs in Crohn's disease in a well-defined cohort
Patients with a history of enterocutaneous fistulae were identified from a prospectively maintained database of 3,200 patients with IBD. Pathology, radiology and laboratory reports were analysed and data extracted retrospectively.
41 CD patients were identified who were treated for ECF (22% post-op; 78% spontaneous) over a 36 year period. Median duration of disease was 19 years. Two thirds involved the small bowel. 17% had distal obstruction. 27% (n=11: 9 spontaneous, 2 post-op) had evidence of infection: 55% associated abscess; 46% positive blood cultures; 91% positive wound swabs. Most had active luminal disease. 76% received nutritional support (62% TPN, 38% enteral). 29% (n=12) were treated with biologics with 50% (n=6) treated pre-operatively. 25% (n=3) achieved fistula control. The mean time from surgery to biologic in those treated post-operatively was 3.5 years. Overall, 14% of our cohort was managed medically while 86% proceeded to surgery. There were no cases of fistula recurrence in surgically treated patients. The overall fistula healing rate at 6 months was 73%.
In this cohort, the majority of ECFs occurred in patients with long-standing, small bowel CD. Biologic therapy has a role to play is selected cases, but he majority of patients required surgical resection with excellent outcomes when combined with appropriate nutritional support.