15 Intestinal Resection Versus Medical Treatment for Ileocecal Crohn's Disease in the Post-Biological Era: A Systematic Review of the Literature
Notice bibliographique
Résumé
Background: Ileocecal Crohn’s disease (CD) is a common presentation of inflammatory bowel disease. In the pre-biological era, surgery was the main therapeutic option after treatment failure. With the advent of anti-TNFα agents, the paradigm shifted, and surgical approaches were reserved for more complex cases. However, growing evidence suggests that early surgery, such as ileocecectomy, may be more effective than primary medical treatment, although no consensus has yet been reached. Therefore, we conducted a systematic review (SR) comparing clinical outcomes of ileal/ileocecal resections with biological therapy in patients with ileocecal CD, focusing on recurrence and complication rates. Methods: A SR was conducted following strict exclusion criteria (PRISMA 2020). Screening adhered to predefined eligibility criteria, with independent dual review, including studies published between 1995 and 2024. A strategic search was performed in PUBMED, PUBMED PMC, BVS/BIREME, CINAHL, WEB OF SCIENCE, EMBASE, COCHRANE LIBRARY, and PROQUEST using descriptors related to Crohn’s disease, ileocecectomy, and immunobiologicals. Results: Eight original studies were included (7 retrospective, one prospective), 7 were developed in countries from Europe, and one was in Canada. Only one included a pediatric population. Of the 8 studies, 2 directly compared ileocolic resection with biological therapy. The remaining studies assessed only surgical outcomes. Five studies evaluated complications after surgical treatment and 1 after medical treatment, with median rates of 10% and 3%, respectively. Five studies analyzed clinical remission rates, and 5 assessed endoscopic remission at varying follow-up times. At approximately 1 year of follow-up, endoscopic remission rates ranged from 29%, 53%, and 79% in the surgical group, and 48% and 84% in the biologics group. Clinical remission was assessed only in the surgical group, with rates of 60%, 83.7%, and 92% at one year, and 74% and 88% at 10 years. CD recurrence after intestinal resection was evaluated in 6 studies, and in 2 of these, it was also possible to assess recurrence in the biologics group. In the direct comparison, surgery vs biological therapy, only one study evaluated the subsequent need for additional biological treatment during follow-up, and it was similar among the groups. Conclusions: Recurrence rates after ileocecal/ileocolic resection for CD varied among studies and were influenced by factors such as smoking, penetrating phenotype, urgent surgery, and upper gastrointestinal tract involvement. Fewer complications occurred after biological therapy; however, the need for additional medical treatment was similar in both approaches. Pediatric patients presented with early postoperative recurrence compared to data from adult patients in the literature. Intestinal resection for ileocecal or isolated ileal CD is an effective alternative to primary biological therapy, particularly in stricturing or complicated disease. These findings suggest that early surgery may also provide significant clinical benefits. Further randomized long-term studies are required to confirm these results.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,010 | 0,008 |
| Bibliométrie | 0,013 | 0,013 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».