Omar Shamaa, MD1, Adam Habib, BA2, Shintaro Akiyama, MD, PhD3, Ahmad G. Tarakji, MD4, Muhammad B. Hammami, MD5, Shadi Hamdeh, MD6 1Henry Ford Hospital, Detroit, MI; 2University of Missouri Kansas City School of Medicine, Leavenworth, KS; 3University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL; 4University of Kansas Medical Center, Kansas City, KS; 5VA Loma Linda Healthcare System, Rancho Cucamonga, CA; 6University of Kansas Medical Center, Lawrence, KS
Introduction: Up to one third of patients with Crohn’s disease (CD) may require bowel surgery within 5 years of diagnosis. In patients with severe perianal disease, the creation of ostomy for fecal diversion (FD) may be necessary. Of those patients, a subgroup will end up with a permanent stoma. The rate of stoma reversal with subsequent intestinal continuity restoration varies in the literature and data in the post biologic era has been controversial. Therefore, we aimed to conduct a meta-analysis study of comparative studies comparing the use of anti tumor necrosis factor (anti-TNF) agents versus not and the rate of successful restoration of intestinal continuity and ostomy closure.
Methods: A comprehensive search of Medline, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus was conducted from each database’s inception to January 16th, 2021. We included comparative studies of anti TNF agents versus nonbiologic therapies in Crohn's disease patients with fecal diversion and looked at the outcome of ostomy reversal and restoration of bowel continuity.
Results: A total of seven studies assessed the use of anti TNF agents in post ostomy. Of this, data from five studies with a total of 348 patients were able to be extracted. Our meta-analysis demonstrated that the use of anti TNF agents post fecal diversion was not associated with a statistically significant risk of reducing the need for permanent ostomy (OR of 01.193; 95% CI: 0.618-2.303; I2= 22.7%). No publication bias was seen among the included studies as seen in the funnel plot.
Discussion: Our meta-analysis showed no difference in ostomy closure rate among patients with Crohn’s disease with ostomy whether anti TNF therapy was used or not. However, our meta-analysis was limited by the small number of total patients included and the lack of randomized controlled trials.
Figure: Effect of anti TNF agents on the rate of successful intestinal continuity restoration and ostomy closure
Omar Shamaa indicated no relevant financial relationships.
Adam Habib indicated no relevant financial relationships.
Shintaro Akiyama indicated no relevant financial relationships.
Ahmad Tarakji indicated no relevant financial relationships.
Muhammad Hammami indicated no relevant financial relationships.
Shadi Hamdeh indicated no relevant financial relationships.
Omar Shamaa, MD1, Adam Habib, BA2, Shintaro Akiyama, MD, PhD3, Ahmad G. Tarakji, MD4, Muhammad B. Hammami, MD5, Shadi Hamdeh, MD6. P1605 - The Use of Anti-TNF Agents in Crohn’s Disease Patients With Fecal Diversion and the Rate of Intestinal Continuity Restoration: A Systematic Review and Meta-Analysis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.