Length Of Ileal Resection Research Articles

The effect of ileal resection length on postoperative complications and prognosis in right colon cancer

BackgroundThere is a lack of literature on the length of the terminal ileum to be resected in right hemicolectomy for colon cancer. Therefore, we aimed to determine the mean ileal loop length and the effect of this variation on postoperative complications and long-term oncological outcomes in patients who underwent right hemicolectomy.MethodsRight hemicolectomy surgeries performed for colon cancer in a tertiary care hospital between January 2011 and December 2018 were retrospectively analyzed from a prospective database. Two patient groups were established based on the mean length of the resected ileum above and below 7 cm. The two groups were compared for clinicopathological data, postoperative complications, mortality, long-term overall survival (OS) and disease-free survival (DFS). The factors contributing to OS and DFS were analyzed.ResultsThe study included 217 patients. Body mass index (BMI) values were significantly higher in the ileum resection length > 7 cm group (p = 0.009). Pathological N stage, tumor diameter, and number of metastatic lymph nodes were significantly higher in the ileum resection length > 7 cm group (p = 0.001, p = 0.001, and p = 0.026, respectively). There was no significant difference for postoperative complication and mortality rates between the two groups. The mean follow-up period was 61.2 months (2-120) in all patients. The total number of deaths was 29 (11.7%) while the 60-month OS was 83.5% and 50-month DFS was 81.8%. There was no significant difference between the groups in terms of OS and DFS rates (p > 0.05).ConclusionsExcessive resection of the distal ileum in right hemicolectomy does not provide any benefit in terms of prognosis and complications.The ileum resection length and values close to it in our study appear to be sufficient.

P202 Performance characteristics of serum FGF19 measurement compared with the Se-HCAT retention test in the diagnosis of bile acid diarrhoea in Crohn’s Disease

Abstract Background Bile acid diarrhoea (BAD) is common in patients with Crohn’s disease (CD), but its recognition is challenging since symptoms are similar to those of active inflammatory disease. The current clinical gold standard for diagnosing BAD is the Se-HCAT test, however, it is inconvenient to the patient and has limited availability. FGF19 is a hormone produced in the enterocytes of the ileum in response to absorbed BAs. Serum FGF19 levels are a direct marker of BA absorption, and they are reduced in BAD. The aim of this study was to evaluate the performance of FGF19 as a diagnostic tool for BAD in Crohn’s disease. Methods Fasting serum FGF19 levels and Se-HCAT retention were measured before bowel preparation in 63 consecutive Crohn’s disease patients referred for an ileocolonoscopy. Clinical, endoscopic and biologic data were prospectively recorded. BAD was defined as an abdominal retention <10% and severe BAD as <5% at day seven. Results BAD was present in 60% of non-resected CD (NR-CD) patients and in 93% of ileal-resected (IR-CD) patients. FGF19 levels were lower in IR-CD patients (median 23 pg/ml; IQR, 3–44) than in the NR-CD patients (61 pg/ml; IQR, 18–121) (p = 0.02). FGF19 levels were inversely related with ileal resection length in IR-CD patients (rs = -0.52, P = 0.01). FGF19 and Se-HCAT values were positively related (rs = 0.57, P < 0.0001), whereas FGF19 was inversely related with the number of bowel movements (rs = -0.31, P=0.01) and Bristol scale (rs = -0.27, P= 0.04). No significant relation was found between FGF19 and clinical (CDAI) nor endoscopic (SES-CD) scores. Area under the ROC curve for FGF19 to detect SeHCAT at <10% and <5% were 0.75 (95% CI 0.62–0.88) and 0.81 (95% CI 0.71–0.92) respectively. Conclusion Serum FGF19 can be used as a simple blood test to the diagnostic of BAD in CD. FGF19 measurement could be an adjunct in guiding treatments for diarrhoea in CD.

Brief report: length of ileal resection correlates with severity of bile acid malabsorption in Crohn's disease.

Bile acid malabsorption (BAM) is a common cause of diarrhoea in Crohn's disease (CD) patients with ileal resection. BAM is usually diagnosed by selenium-labelled homotaurocholic acid test (75SeHCAT) but its availability is limited. Consequently, a large proportion of patients either remain undiagnosed or subject to empirical therapy. There is a paucity of studies examining the correlation between length of ileal resection and severity of BAM, which will be of use to clinicians with no recourse to diagnostic testing for BAM. We tested the correlation between length of resected ileum and percentage retention on 75SeHCAT of all CD patients with a prior surgical resection who underwent 75SeHCAT testing. Response to treatment with bile salt sequestrant and 75SeHCAT retention values was tested using Fisher's exact test. A total of 91 patients were identified with a median age of 47 (IQR 21-80). The median length of resected ileum was 24cm (range 15-165cm) with a median of 1 resection (range 1-4). Overall, 88 patients (97%) had 75SeHCAT retention values of < 10% and 85 (93%) had retention of < 5%. There was a modest correlation between 75SeHCAT retention and length of ileal resection (Spearman's rho - 0.392, P = 0.0001). Data on response to treatment was available for 57 (63%) patients, of who 38 (67%) responded to bile salt sequestrant. There was no difference in 75SeHCAT retention values between responders and non-responders. There was a modest correlation between length of ileal resection and severity of BAM as defined by 75SeHCAT retention values. Response to bile salt sequestrant therapy was not dependent on 75SeHCAT retention values.

PTH-087 Severity of Bile Acid Malabsorption Does Not Correlate with Length of Ileal Resection or Response to Bile Salt Sequestrant Therapy in Crohn’s Disease

Introduction Bile acid malabsorption (BAM) is a common cause of diarrhoea in Crohn’s disease (CD) patients with ileal resection and can lead to complications such as renal and biliary stone disease. BAM is usually diagnosed by selenium labelled homo-taurocholic acid test (75 SeHCAT) but its availability is limited. Thus, large proportions of resected CD patients either remain undiagnosed or subject to empirical therapy. There is a paucity of studies examining the correlation between length of ileal resection and severity of BAM which will be of particular use to clinicians with no recourse to diagnostic testing for BAM. Methods We identified all CD patients with a prior surgical resection who underwent 75 SeHCAT testing at our institute. Testing was based on the treating clinician’s discretion. The length of resected ileum was recorded from histopathology report. Correlation between length of resected ileum and percentage retention on 75 SeHCAT was assessed using a Spearman’s correlation test. Response to treatment with bile salt sequestrant and 75 SeHCAT retention values (using a cut point of 5%) was analysed using Fisher’s exact test. Results A total of 40 patients were identified with a mean age of 45 (SD±13), of which 6 (15%) were men. The median length of resected ileum was 22.8 cms (range 5.8–61.0 cms) with a median of 1 resection (range 1–4). Overall, 38 patients (95%) had 75 SeHCAT retention values of 5% and the remaining 18 (86%) had values Conclusion There was no correlation between length of ileal resection and severity of BAM as defined by 75 SeHCAT retention values. Response to bile salt sequestrant therapy was not dependent on 75 SeHCAT retention values though overall clinical response was good. Disclosure of Interest K. Lo: None Declared, H. Riyat: None Declared, Y. Prasad: None Declared, S. Subramanian Speaker bureau with: MSD, Abbvie, Shire, Ferring, Actavis, Conflict with: Advisory board Boehringer-Ingelheim, Vifor pharma, MSD, Abbvie, Shire

Diarrhea in Crohn’s disease: investigating the role of the ileal hormone fibroblast growth factor 19.

Bile acids [BA] are usually reabsorbed by the terminal ileum, but this process is frequently abnormal in Crohn’s disease [CD]. BA malabsorption occurs, and excess colonic BA cause secretory diarrhea. Furthermore, the hormone fibroblast growth factor 19 [FGF19] is synthesized in the ileum in response to BA absorption and regulates BA synthesis. We hypothesized that reduced serum FGF19 levels will be associated with diarrheal symptoms and disease activity in both ileal resected[IR-CD] and non-resected CD [NR-CD] patients. Fasting serum FGF19 levels were measured in 58 patients [23 IR-CD patients and 35NR-CD patients]. Disease activity was assessed using the Harvey Bradshaw Index and C-reactive protein [CRP]. Stool frequency, Bristol Stool Form Scale and length of previous ileal resection were recorded. FGF19 levels were also compared with healthy and diarrhea control patients. FGF19 levels were inversely correlated with ileal resection length in IR-CD patients[r = -0.54, p = 0.02]. In NR-CD patients, median FGF19 levels were significantly lower in patients with active disease compared with inactive disease [103 vs. 158 pg/ml, p = 0.04] and in those with symptoms of diarrhea compared with those without [86 vs. 145 pg/ml, p = 0.035]. FGF19 levels were inversely correlated with stool frequency, Bristol stool form and CRP in NR-CD patients with ileal disease. Reduced FGF19 levels are associated with ileal resection, diarrhea and disease activity. FGF19 may have utility as a biomarker for functioning ileum in CD. This study supports a potential role of FGF19 in guiding treatments for diarrhea in Crohn’s disease.

PTH-107 A Preliminary Study Of The Effects Of Obeticholic Acid, A Farnesoid X Receptor Agonist, In Patients With Chronic Diarrhoea Secondary To Crohn’s Ileal Disease

IntroductionChronic diarrhoea occurs frequently as a result of excess faecal bile acid (BA) loss. Secondary bile acid diarrhoea (SBAD) is common in Crohn’s disease with ileal inflammation and/or resection. The...

PWE-093 Screening with Holotranscobalamin is Superior to Serum B12 in Identifying Vitamin B12 Deficiency in Patients with Crohn’S Disease

IntroductionRisk factors for vitamin B12 deficiency in patients with Crohn’s disease (CD) include ileal disease and previous ileal resections. Screening for B12 deficiency is traditionally through serum B12 which is...

The long-term sequelae of ileocolic anastomosis in childhood: A retrospective survey

The long-term effects of ileocolic anastomosis in children are not known. We therefore carried out a survey of all such patients treated at our hospital between 1971 and 1985. Thirty-seven patients were identified and invited to attend for follow-up. Twenty-seven (73 per cent) were examined and included in the survey. Mean age at survey was 7.8 years (range 1.6-17.6 years) and mean duration since operation was 6.3 years. Necrotizing enterocolitis and intussusception were the commonest indications for operation. As judged by height, weight and skin fold thickness, all patients were well nourished. Seven (26 per cent) had loose stools, five had chronic folic acid deficiency and one was vitamin B12 deficient. We conclude that resection of the ileocaecal region is well tolerated in childhood and does not affect growth. Loose stools are directly related to the length of ileal resection.

Oral Budesonide Significantly Improves Water Absorption in Patients with Ileostomy for Crohn Disease

Background: In addition to their anti-inflammatory effects, steroids influence electrolyte and water transport systems in the intestinal mucosa. This study analysed the effect of the topically acting glucocorticoid budesonide on ileostomy output in patients with Crohn disease. Methods: Oral budesonide (3 mg/three times daily for 8 days; n = 20) was compared to placebo (n = 20) in a doubleblind design using matched-pair randomization according to ileal resection length in patients without detectable inflammatory activity. Under controlled hospital conditions, absolute output volumes were measured and response was defined as a reduction in intestinal output of >25% compared to pretreatment conditions. Results: In the treatment group, we observed an absolute decrease in median intestinal output from 1,240 ml to 865 ml (30.2%), compared to 0.3% under placebo (from 950 ml to 947.5 ml). Response was documented in 60% (12/20 patients) in the treatment group compared to no response under placebo (P < 0.0001). While both treatment groups showed similar absolute median reductions (400 ml with ileal resection ≤20 cm and 405 ml with ileal resection >20 cm), the relative reduction (response rate) was lower in the subgroup of an ileal resection >20 cm (36%) due to the greater increase in output secondary to the loss of ileum. Conclusions: These data support the assumption that the absorptive capacity of the intestinal mucosa for water may be improved by topically acting steroids and suggest that this occurs independently of their anti-inflammatory effect.

Long-term clinical course and prognostic factors in intestinal Behçet's disease.

The present study was aimed at evaluating the long-term course of intestinal Behçet's disease and determining predictive factors of prognosis. This report is a retrospective study based on the records of 43 patients with intestinal Behçet's disease. The mean follow-up duration was 73 +/- 60 months. We evaluated the efficacy of medical treatment for the intestinal lesion at initial eight weeks. The cumulative probabilities were calculated by using Kaplan-Meier method, and the results were compared by using the log-rank test. Sixteen patients (38 percent) achieved a complete remission of intestinal lesions eight weeks after medical treatment had begun. The patients who achieved a complete remission had a lower probability of receiving an operation than those who had not (13 percent at 2 and 5 years vs. 36 and 43 percent, respectively; P = 0.028). The recurrence probability of intestinal lesions was 25 percent at two years and 49 percent at five years after complete remission with medical treatment. Patients who had a history of intestinal perforation or fistula had a higher probability of recurrence after operation than those without such history (59 vs. 33 percent at 2 years; 88 vs. 57 percent at 5 years; P = 0.020). Patients who had taken azathioprine had a lower probability of receiving reoperation than those who did not (7 vs. 25 percent at 2 years; 25 vs. 47 percent at 5 years; P = 0.035). The length of ileal resection and whether hemicolectomy was performed had no significant effect on the recurrence or reoperation rate. Intestinal Behçet's disease frequently requires a surgical treatment and has a high recurrence rate. The patients who achieved a complete remission with medical treatment, who had no history of intestinal perforation, and who received azathioprine after operation showed better clinical courses. Resection of a short segment of bowel would be a more appropriate surgical procedure.

Decreased absorption of ingested unconjugated chenodeoxycholic acid in patients with Crohn's disease.

The intestinal absorption of unconjugated chenodeoxycholic acid (CDA) was studied in 27 healthy individuals and 28 patients with Crohn's disease who had undergone ileal resection. After they had taken 1 g CDA orally serum levels of bile acids were significantly lower in the patients than in the healthy individuals; the difference was apparent already 30 min after ingestion. There was no correlation between CDA absorption and recurrent disease, length of ileal resection, or number of defecations. These findings indicate that the intestinal absorption of ingested CDA in patients with Crohn's disease is decreased. Since CDA is absorbed mainly in proximal areas of the gut, these observations may indicate that proximal areas are involved in ileocolic Crohn's disease.

ROLE OF THE COLON IN ILEAL-RESECTION DIARRHŒA

The diarrhœa that follows ileal resection has been studied in nine patients on identical diets in order to identify the factors responsible. The severity of the diarrhœa, as expressed by the fæcal weight, increased as the length of any associated colonic resection increased, and was much less influenced by the length of ileal resection. Fæcalfat output increased as the length of ileal resection increased, but did not correlate with fæcal weight. Fæcal-electrolyte composition was more closely related to the amount of residual colon than to the amount of residual ileum, and transit-time was slower in patients in whom more colon had been preserved. Ileal resection may increase the load delivered to the colon, resulting in diarrhœa when the absorptive capacity of the colon is reduced by disease or resection. It is important to preserve as much colon as possible at operation, since this will contribute significantly to the future wellbeing of the patient.