Letter: faecal diversion for severe perianal Crohn's disease - practical issues. Authors' reply
Year: 2015
Type: letter
Abstract: We thank Drs Yamamoto and Shimoyama for their interest in our study,1, 2 and reiterating the findings of our systematic review that faecal diversion for severe perianal Crohn's disease (CD) may offer short-term clinical benefit, but carries a low likelihood of successful restoration of bowel continuity even in the biological era. Ideally, we anticipate that with temporary faecal diversion, there would not be increased risk of cancer in the diverted colon. However, if there are no plans to restore bowel continuity, then we agree that total proctocolectomy with end-ileostomy would be prudent to minimise complications such as diversion colitis and cancer arising in the diverted colon. If however the diverted colon is left in place, periodic surveillance should be considered, although cancer in the diverted segment is a rare occurrence. In a Dutch retrospective review of 74 patients with Crohn's disease undergoing faecal diversion who underwent surveillance of the defunctioned colon, no cases of colonic dysplasia or malignancy were identified over cumulative follow-up time of 238.8 years.3 There is also a rare risk of cancer arising in the anorectum in patients with chronic perianal fistulae. While our study was not focused on cancer risk in a defunctioned anorectum, previous studies have suggested a rare risk of anorectal cancers arising from perianal fistulae.4, 5 In a systematic review of 23 case reports and case series, Iesalnieks et al. identified 65 cases of fistula-associated anorectal cancer, although these were not diverted patients.6 Given the relative rarity of these cancers, large-scale population registry studies would have to be conducted to further answer these questions. Until then, it would be prudent to perform careful examination of the diverted colon and rectum and perianal region with biopsies and/or curettage of the tracts on a periodic basis. The authors’ declarations of personal and financial interests are unchanged from those in the original article.2
DOI: 10.1111/apt.13410
Authors: S. Singh, N. S. Ding, investigators
Language: English
Topic: Inflammatory Bowel Disease
Subfield: Genetics
Domain: Life Sciences
Open Access status: bronze
OpenAlex ID: W2139591154