Initial management of intraabdominal abscesses and preventive strategies for abscess recurrence in penetrating Crohn's disease: a national multicenter study based on ENEIDA registry.

Fecha de publicación: 01/11/2023 Fecha Ahead of Print: 01/11/2023

Autores de IIS La Fe

Javier Pérez Gisbert

Autor
Elena Cerrillo Bataller

Autor

Participantes ajenos a IIS La Fe

Casas Deza, Diego
Polo Cuadro, Cristina
de Francisco, Ruth
Vela Gonzalez, Milagros
Bermejo, Fernando
Blanco, Ignacio
de la Serna, Alvaro
Bujanda, Luis
Bernal, Lorena
Rueda Garcia, Jose Luis
Gargallo-Puyuelo, Carla J
Fuentes-Valenzuela, Esteban
Castro, Beatriz
Guardiola, Jordi
Ladron, Gemma
Suria, Carles
Saez Fuster, Julia
Sicilia, Beatriz
Gomez, Raquel
Munoz Vilafranca, Carmen
Barreiro-De Acosta, Manuel
Pena, Elena
Castillo Pradillo, Marta
Calvet, Xavier
Mancenido, Noemi
Monfort I Miquel, David
Marin, Sandra
Roig, Cristina
Marce, Ainhoa
de Piscina, Patricia Ramirez
Betore, Elena
Martin-Cardona, Albert
Teller, Marta
Alonso Abreu, Inmaculada
Maroto, Nuria
Frago, Santiago
Gardeazabal, Diego
Perez-Martinez, Isabel
Febles Gonzalez, Angel David
Barrero, Sara
Taxonera, Carlos
de la Filia, Irene Garcia
Ezkurra-Altuna, Ander
Madero, Lucia
Martin-Arranz, Maria Dolores
Gomollon, Fernando
Domenech, Eugeni
Garcia-Lopez, Santiago
ENEIDA registry by GETECCU

Grupos

Enfermedad Inflamatoria Intestinal

Leader

Pilar Nos Mateu

Abstract

INTRODUCTION: Intra-abdominal abscesses complicating Crohn's disease (CD) are a challenging situation. Their management, during the hospitalization and after resolution, is still unclear. METHODS: Adult patients with CD complicated with intraabdominal abscess who required hospitalization 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: 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 < 30mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50mm, 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, while 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.