Search in the Abstract Database

Search Abstracts 2015

* = Presenting author

P197 Retrospective Analysis of Enterocutaneous Fistula Management in IBD

M. Boyle*, G. Doherty, G. Cullen

St Vincents University Hospital, Gastroenterology, Dublin, Ireland

Background

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

Methods

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.

Results

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%.

Conclusion

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.