Early ileocaecal resection in CD patients failing conventional treatment

In the LIR!C trial, laparoscopic ileocaecal resection in Crohn’s disease (CD) patients not responding to conventional treatment was at least as good as anti-TNF in terms of quality of life and was cost-saving [1]. Long-awaited long-term follow-up data support early surgery in these patients [2].

In the original LIR!C trial, 73 patients with limited, non-stricturing, ileocaecal CD who had failed on conventional therapy were allocated to have resection and 70 to receive infliximab [1]. At 12 months, the mean Inflammatory Bowel Disease Questionnaire (IBDQ) score was 178.1 and 172.0 in the respective groups (P=0.25).

Long-term follow-up data were presented by Dr Toer Stevens (Amsterdam UMC, the Netherlands). In the resection group, 18 (26%) patients started anti-TNF treatment, none required a second resection, and 29 (42%) did not require additional CD-related treatment [2]. In the infliximab group, 31 (48%) patients moved on to a CD-related resection. In both groups, around 60% of patients required additional treatment at some point during follow-up. Duration of treatment effect was similar: median time without additional treatment was 33 months (95% CI 15.1–50.9) and 34 months (95% CI 0–69.3) in the resection and infliximab group, respectively (P=0.521). In both groups, prophylactic immunomodulators decreased the risk of additional treatment. Dr Stevens concluded: “These data support early laparoscopic ileocaecal resection in non-stricturing ileocaecal CD patients failing conventional treatment.”

1. 
   
   1. Ponsioen CY, et al. Lancet Gastroenterol Hepatol. 2017;2(11):785-792.
   2. Stevens T, et al. ECCO-IBD 2020, OP03.

 



Posted on 14 April 20208 April 2024