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IBD Journal Scan

Key articles from high impact journals in last month

Editorial Recommendations

OCTOBER-2024

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Comparison of Kono-S vs. Stapled Ileocolic Anastomosis in Crohn's Disease: A Randomized Controlled Trial

This trial compared the Kono-S and stapled side-to-side ileocolic anastomoses in Crohn's disease patients. Among 79 participants, the Kono-S group had significantly lower rates of endoscopic recurrence (22.2% vs. 62.8%) at 6 months. Severe recurrence (Rutgeerts score ≥i3) was also lower (13.8% vs. 34.8%). Clinical recurrence rates were lower in the Kono-S group at 24 months (18% vs. 30.2%). No significant difference in surgical recurrence was observed. Overall, the Kono-S anastomosis was associated with reduced recurrence risk and prolonged time to recurrence. Postoperative outcomes were similar across both groups.

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Impact of Kono-S Anastomosis on Quality of Life After Ileocolic Resection for Crohn's Disease

This study assessed the impact of Kono-S vs. conventional side-to-side anastomosis on quality of life in Crohn’s disease patients after ileocolic resection. Of the 94 patients, 51 received the conventional and 43 the Kono-S anastomosis. After a mean follow-up of 54 months, Kono-S patients reported improved bowel symptoms (P = 0.002) and social function (P = 0.02). Total IBDQ scores were higher in the Kono-S group, though not significantly (P = 0.11). Kono-S anastomosis was independently associated with better outcomes for bowel symptoms and social function. Overall, Kono-S improves quality of life in these key areas.

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Extended vs. Conventional Mesenteric Resection in Crohn's Disease: A Randomized Trial

This trial compared extended mesenteric resection with conventional mesenteric sparing resection in Crohn's disease patients undergoing ileocolic resection. Among 139 enrolled patients, 131 were analyzed for the primary outcome. After 6 months, endoscopic recurrence rates were similar between the extended (42%) and conventional (43%) groups (P = 1.0). Postoperative anastomotic leakage occurred more frequently in the extended group (8% vs. 2%). Complications of Clavien-Dindo grade IIIa or higher were reported in 11% of extended resection patients and 8% of conventional. The findings support using mesenteric sparing as recommended by current guidelines.

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Comparison of Biologics, Anti-TNFs, and Immunomodulators in Preventing Postoperative Recurrence in Crohn's Disease

This study compared the efficacy of novel biologics (vedolizumab, ustekinumab), anti-TNF agents, and immunomodulators (IMMs) in preventing postoperative recurrence (POR) in Crohn's disease. A meta-analysis of 17 studies with 2786 patients showed that anti-TNFs, vedolizumab, and IMMs were effective in preventing endoscopic POR, while anti-TNFs and IMMs also reduced clinical POR. The network analysis ranked vedolizumab as the most effective in preventing endoscopic POR, and anti-TNFs best at reducing clinical POR. Overall, novel biologics, particularly vedolizumab, and anti-TNFs were highly effective in preventing recurrence after surgery.

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Azathioprine Plus Enteral Nutrition Reduces Postoperative Recurrence in Crohn’s Disease

This trial investigated whether adding 3 months of exclusive enteral nutrition (EEN) to azathioprine (AZA) post-surgery is more effective than AZA alone in preventing endoscopic recurrence (ER) in high-risk Crohn’s disease patients. Among 84 participants, the AZA + EEN group had significantly lower ER rates at 12 months (33.3% vs. 63.2%) and 3 months (8.6% vs. 28.1%). Clinical recurrence rates, CDAI scores, and inflammatory markers were similar between groups. Quality of life was initially lower with AZA + EEN but comparable by 12 months. The combination therapy effectively reduces ER, warranting further research.

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