Surgical Outcomes of Very-early-onset Ulcerative Colitis: Retrospective Comparative Study with Older Pediatric Patients

Overview

Journal Pediatr Surg Int

Specialties General Surgery
Pediatrics

Date 2024 Mar 7

PMID 38451357

Authors

Takashi Fumita

Keita Terui

Ryohei Shibata

Ayako Takenouchi

Shugo Komatsu

Satoru Oita

Hiroko Yoshizawa

Yuichi Hirano

Yusaku Yoshino

Takeshi Saito

Tomoro Hishiki

Affiliations

Soon will be listed here.

Abstract

Purpose: The study compares the surgical outcomes of very-early-onset ulcerative colitis (VEO-UC), which is a rare disease diagnosed in pediatric patients < 6 years, with those of older pediatric patients with ulcerative colitis (UC).

Methods: A retrospective observational study of 57 pediatric patients with UC was conducted at a single center. The study compared surgical complications and postoperative growth between the two groups.

Results: Out of the 57 patients, 6 had VEO-UC, and 5 of them underwent total colectomy. Compared with the surgical cases of older patients with UC (n = 6), the rate of postoperative complications in patients with VEO-UC (n = 5) was not significantly different, except for high-output ileostomy (80% vs. 0% at 3 weeks postoperatively, p = 0.02). The rate of postoperative central venous catheter (CVC) placement at > 90 days was higher in patients with VEO-UC (100% vs. 17%, p = 0.02). The median change in the Z-score of height before and 2 years after colectomy was not significantly different between VEO-UC and older patients (1.1 vs. 0.3, p = 0.13).

Conclusion: With regard to complications and outcomes, total colectomy for VEO-UC patients and that for older pediatric UC patients is comparable. However, high-output ileostomy and the long duration of CVC placement may pose management challenges.

References

Shivashankar R, Tremaine W, Harmsen W, Loftus Jr E . Incidence and Prevalence of Crohn's Disease and Ulcerative Colitis in Olmsted County, Minnesota From 1970 Through 2010. Clin Gastroenterol Hepatol. 2016; 15(6):857-863. PMC: 5429988. DOI: 10.1016/j.cgh.2016.10.039. View

Van Limbergen J, Russell R, Drummond H, Aldhous M, Round N, Nimmo E . Definition of phenotypic characteristics of childhood-onset inflammatory bowel disease. Gastroenterology. 2008; 135(4):1114-22. DOI: 10.1053/j.gastro.2008.06.081. View

Tan Tanny S, Yoo M, Hutson J, Langer J, King S . Current surgical practice in pediatric ulcerative colitis: A systematic review. J Pediatr Surg. 2018; 54(7):1324-1330. DOI: 10.1016/j.jpedsurg.2018.08.050. View

Ouahed J, Spencer E, Kotlarz D, Shouval D, Kowalik M, Peng K . Very Early Onset Inflammatory Bowel Disease: A Clinical Approach With a Focus on the Role of Genetics and Underlying Immune Deficiencies. Inflamm Bowel Dis. 2019; 26(6):820-842. PMC: 7216773. DOI: 10.1093/ibd/izz259. View

Rialon K, Crowley E, Seemann N, Fahy A, Muise A, Langer J . Long-term outcomes for children with very early-onset colitis: Implications for surgical management. J Pediatr Surg. 2018; 53(5):964-967. DOI: 10.1016/j.jpedsurg.2018.02.023. View

Rinawi F, Assa A, Bashir H, Peleg S, Shamir R . Clinical and Phenotypic Differences in Inflammatory Bowel Disease Among Arab and Jewish Children in Israel. Dig Dis Sci. 2017; 62(8):2095-2101. DOI: 10.1007/s10620-017-4623-x. View

Yodoshi T, Hurt T . Fecal Microbiota Transplantation to Patients with Refractory Very Early Onset Ulcerative Colitis. Pediatr Gastroenterol Hepatol Nutr. 2018; 21(4):355-360. PMC: 6182486. DOI: 10.5223/pghn.2018.21.4.355. View

Fielding A, Woods R, Moosvi S, Wharton R, Speakman C, Kapur S . Renal impairment after ileostomy formation: a frequent event with long-term consequences. Colorectal Dis. 2019; 22(3):269-278. DOI: 10.1111/codi.14866. View

Usami M, Takeuchi I, Kyodo R, Hirano Y, Kashiwagi K, Fujikawa H . Clinical features of very early-onset inflammatory bowel disease in Japan: a retrospective single-center study. Intest Res. 2022; 20(4):475-481. PMC: 9650330. DOI: 10.5217/ir.2021.00142. View

10.

Ng K, Gonsalves S, Sagar P . Ileal-anal pouches: A review of its history, indications, and complications. World J Gastroenterol. 2019; 25(31):4320-4342. PMC: 6710180. DOI: 10.3748/wjg.v25.i31.4320. View

11.

Knod J, Holder M, Cortez A, Martinez-Leo B, Kern P, Saeed S . Surgical outcomes, bowel habits and quality of life in young patients after ileoanal anastomosis for ulcerative colitis. J Pediatr Surg. 2016; 51(8):1246-50. DOI: 10.1016/j.jpedsurg.2016.03.002. View

12.

Griffiths A . Specificities of inflammatory bowel disease in childhood. Best Pract Res Clin Gastroenterol. 2004; 18(3):509-23. DOI: 10.1016/j.bpg.2004.01.002. View

13.

Nicholls S, Vieira M, Majrowski W, Shand W, Savage M, Walker-Smith J . Linear growth after colectomy for ulcerative colitis in childhood. J Pediatr Gastroenterol Nutr. 1995; 21(1):82-6. DOI: 10.1097/00005176-199507000-00014. View

14.

Lee J, Kang M, Kim H, Shin S, Kim H, Kim E . Enterostomy closure timing for minimizing postoperative complications in premature infants. Pediatr Neonatol. 2014; 55(5):363-8. DOI: 10.1016/j.pedneo.2014.01.001. View

15.

Siow V, Bhatt R, Mollen K . Management of acute severe ulcerative colitis in children. Semin Pediatr Surg. 2017; 26(6):367-372. DOI: 10.1053/j.sempedsurg.2017.10.006. View

16.

Benchimol E, Mack D, Nguyen G, Snapper S, Li W, Mojaverian N . Incidence, outcomes, and health services burden of very early onset inflammatory bowel disease. Gastroenterology. 2014; 147(4):803-813.e7. DOI: 10.1053/j.gastro.2014.06.023. View

17.

Cucinotta U, Arrigo S, Dipasquale V, Gramaglia S, Lagana F, Romano C . Clinical Course of Very Early-Onset Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr. 2023; 76(5):590-595. DOI: 10.1097/MPG.0000000000003730. View

18.

Heyman M, Kirschner B, Gold B, Ferry G, Baldassano R, Cohen S . Children with early-onset inflammatory bowel disease (IBD): analysis of a pediatric IBD consortium registry. J Pediatr. 2005; 146(1):35-40. DOI: 10.1016/j.jpeds.2004.08.043. View

19.

Levine A, Griffiths A, Markowitz J, Wilson D, Turner D, Russell R . Pediatric modification of the Montreal classification for inflammatory bowel disease: the Paris classification. Inflamm Bowel Dis. 2011; 17(6):1314-21. DOI: 10.1002/ibd.21493. View

20.

Ruemmele F, El Khoury M, Talbotec C, Maurage C, Mougenot J, Schmitz J . Characteristics of inflammatory bowel disease with onset during the first year of life. J Pediatr Gastroenterol Nutr. 2006; 43(5):603-9. DOI: 10.1097/01.mpg.0000237938.12674.e3. View