Initial Management of Intra-abdominal Abscesses and Preventive Strategies for Abscess Recurrence in Penetrating Crohn’s Disease: A National, Multicentre Study Based on ENEIDA Registry
Diego Casas Deza, Cristina Polo Cuadro, Ruth de Francisco, Milagros Vela González, Fernando Bermejo, Ignacio Blanco, Álvaro de la Serna, Luís Bujanda, Lorena Bernal, J L Rueda García, Carla J. Gargallo-Puyuelo, Esteban Fuentes-Valenzuela, Beatriz Castro, Jordi Guardiola, Gemma Ladrón, Carles Suria, J. Fustér, Javier P. Gisbert, Beatriz Sicilia, R. Gómez, Carmen Muñoz Vilafranca, Manuel Barreiro‐de Acosta, Elena Peña, Marta Castillo Pradillo, Elena Cerrillo, Xavier Calvet, Noemí Manceñido, David Monfort i Miquel, Sandra Soro Marín, Cristina Roig, Ainhoa Marcé, Patricia Ramírez de la Piscina, Elena Betoré Glaría, Albert Martín‐Cardona, Marta Téller, Inmaculada Alonso Abreu, Nuria Maroto, Santiago Frago, Diego Gardeazabal, Isabel Pérez‐Martínez, Ángel David Febles González, Sara Barrero, Carlos Taxonera, Irene García de la Filia, Ander Ezkurra-Altuna, L Madero, María Dolores Martín‐Arranz, Fernando Gomollón, Eugeni Domènech, Santiago García‐López
Abstract
INTRODUCTION: Intra-abdominal abscesses complicating Crohn's disease [CD] are a challenging situation. Their management, during hospitalisation and after resolution, is still unclear. METHODS: Adult patients with CD complicated with intra-abdominal abscess. who required hospitalisation, 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: In all, 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 < 30 mm, the antibiotic was as effective as percutaneous or surgical drainage. However, in larger abscesses, percutaneous or surgical drainage was superior. In abscesses > 50 mm, 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; 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.