Endoscopic ultrasound to guide the combined medical and surgical management of pediatric perianal Crohn's disease

Michael J. Rosen, Dedrick E. Moulton, Tatsuki Koyama, Walter M. Morgan, Stephen E. Morrow, Alan Joseph Herline, Roberta L. Muldoon, Paul E. Wise, D. Brent Polk, David A. Schwartz

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: Perianal fistulas are a debilitating manifestation of Crohn's disease (CD) in the pediatric population and present a management challenge. The aims of this study were to describe our experience using endoscopic ultrasound (EUS) to guide management of perianal CD (PCD) in a pediatric population, and determine whether using EUS to monitor healing after seton placement improves outcomes. Methods: We conducted a retrospective study of 2 cohorts: pediatric subjects with PCD who underwent EUS and pediatric subjects who underwent seton placement between 2002 and 2007. Results: In all, 25 children underwent a total of 42 EUS procedures. Of 28 EUSs performed to evaluate suspected perianal disease, complex fistulizing disease was identified in 15 (54%). Setons were placed after most EUSs demonstrating complex fistulizing disease and after none demonstrating superficial or no fistulizing disease. Of 14 EUSs performed to monitor healing around a seton, 7 (50%) demonstrated persistent peri-seton inflammation. Setons were more often left in place after an EUS revealing persistent inflammation (86% versus 0%), and the patients were more likely to have a biologic initiated or changed (57% versus 0%). Among all subjects who underwent seton placement, time from seton removal to recurrence was longer for those followed by EUS compared to those followed by physical exam only; however, we were not powered to test for statistical significance. Conclusions: EUS to guide the combined medical and surgical management of PCD is feasible in the pediatric population. Larger prospective studies are needed to determine if EUS-directed management improves outcomes in pediatric patients with PCD.

Original languageEnglish (US)
Pages (from-to)461-468
Number of pages8
JournalInflammatory Bowel Diseases
Volume16
Issue number3
DOIs
StatePublished - Feb 26 2010

Fingerprint

Pediatrics
Population
Inflammation
Crohn Disease
Fistula
Retrospective Studies
Pediatric Crohn's disease
Prospective Studies
Recurrence

Keywords

  • Crohn's disease
  • Endosonography
  • Fistula
  • Pediatrics

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology

Cite this

Rosen, M. J., Moulton, D. E., Koyama, T., Morgan, W. M., Morrow, S. E., Herline, A. J., ... Schwartz, D. A. (2010). Endoscopic ultrasound to guide the combined medical and surgical management of pediatric perianal Crohn's disease. Inflammatory Bowel Diseases, 16(3), 461-468. https://doi.org/10.1002/ibd.21067

Endoscopic ultrasound to guide the combined medical and surgical management of pediatric perianal Crohn's disease. / Rosen, Michael J.; Moulton, Dedrick E.; Koyama, Tatsuki; Morgan, Walter M.; Morrow, Stephen E.; Herline, Alan Joseph; Muldoon, Roberta L.; Wise, Paul E.; Polk, D. Brent; Schwartz, David A.

In: Inflammatory Bowel Diseases, Vol. 16, No. 3, 26.02.2010, p. 461-468.

Research output: Contribution to journalArticle

Rosen, MJ, Moulton, DE, Koyama, T, Morgan, WM, Morrow, SE, Herline, AJ, Muldoon, RL, Wise, PE, Polk, DB & Schwartz, DA 2010, 'Endoscopic ultrasound to guide the combined medical and surgical management of pediatric perianal Crohn's disease', Inflammatory Bowel Diseases, vol. 16, no. 3, pp. 461-468. https://doi.org/10.1002/ibd.21067
Rosen, Michael J. ; Moulton, Dedrick E. ; Koyama, Tatsuki ; Morgan, Walter M. ; Morrow, Stephen E. ; Herline, Alan Joseph ; Muldoon, Roberta L. ; Wise, Paul E. ; Polk, D. Brent ; Schwartz, David A. / Endoscopic ultrasound to guide the combined medical and surgical management of pediatric perianal Crohn's disease. In: Inflammatory Bowel Diseases. 2010 ; Vol. 16, No. 3. pp. 461-468.
@article{fc4cc6c5dbf54a31bbb11a11545a2411,
title = "Endoscopic ultrasound to guide the combined medical and surgical management of pediatric perianal Crohn's disease",
abstract = "Background: Perianal fistulas are a debilitating manifestation of Crohn's disease (CD) in the pediatric population and present a management challenge. The aims of this study were to describe our experience using endoscopic ultrasound (EUS) to guide management of perianal CD (PCD) in a pediatric population, and determine whether using EUS to monitor healing after seton placement improves outcomes. Methods: We conducted a retrospective study of 2 cohorts: pediatric subjects with PCD who underwent EUS and pediatric subjects who underwent seton placement between 2002 and 2007. Results: In all, 25 children underwent a total of 42 EUS procedures. Of 28 EUSs performed to evaluate suspected perianal disease, complex fistulizing disease was identified in 15 (54{\%}). Setons were placed after most EUSs demonstrating complex fistulizing disease and after none demonstrating superficial or no fistulizing disease. Of 14 EUSs performed to monitor healing around a seton, 7 (50{\%}) demonstrated persistent peri-seton inflammation. Setons were more often left in place after an EUS revealing persistent inflammation (86{\%} versus 0{\%}), and the patients were more likely to have a biologic initiated or changed (57{\%} versus 0{\%}). Among all subjects who underwent seton placement, time from seton removal to recurrence was longer for those followed by EUS compared to those followed by physical exam only; however, we were not powered to test for statistical significance. Conclusions: EUS to guide the combined medical and surgical management of PCD is feasible in the pediatric population. Larger prospective studies are needed to determine if EUS-directed management improves outcomes in pediatric patients with PCD.",
keywords = "Crohn's disease, Endosonography, Fistula, Pediatrics",
author = "Rosen, {Michael J.} and Moulton, {Dedrick E.} and Tatsuki Koyama and Morgan, {Walter M.} and Morrow, {Stephen E.} and Herline, {Alan Joseph} and Muldoon, {Roberta L.} and Wise, {Paul E.} and Polk, {D. Brent} and Schwartz, {David A.}",
year = "2010",
month = "2",
day = "26",
doi = "10.1002/ibd.21067",
language = "English (US)",
volume = "16",
pages = "461--468",
journal = "Inflammatory Bowel Diseases",
issn = "1078-0998",
publisher = "John Wiley and Sons Inc.",
number = "3",

}

TY - JOUR

T1 - Endoscopic ultrasound to guide the combined medical and surgical management of pediatric perianal Crohn's disease

AU - Rosen, Michael J.

AU - Moulton, Dedrick E.

AU - Koyama, Tatsuki

AU - Morgan, Walter M.

AU - Morrow, Stephen E.

AU - Herline, Alan Joseph

AU - Muldoon, Roberta L.

AU - Wise, Paul E.

AU - Polk, D. Brent

AU - Schwartz, David A.

PY - 2010/2/26

Y1 - 2010/2/26

N2 - Background: Perianal fistulas are a debilitating manifestation of Crohn's disease (CD) in the pediatric population and present a management challenge. The aims of this study were to describe our experience using endoscopic ultrasound (EUS) to guide management of perianal CD (PCD) in a pediatric population, and determine whether using EUS to monitor healing after seton placement improves outcomes. Methods: We conducted a retrospective study of 2 cohorts: pediatric subjects with PCD who underwent EUS and pediatric subjects who underwent seton placement between 2002 and 2007. Results: In all, 25 children underwent a total of 42 EUS procedures. Of 28 EUSs performed to evaluate suspected perianal disease, complex fistulizing disease was identified in 15 (54%). Setons were placed after most EUSs demonstrating complex fistulizing disease and after none demonstrating superficial or no fistulizing disease. Of 14 EUSs performed to monitor healing around a seton, 7 (50%) demonstrated persistent peri-seton inflammation. Setons were more often left in place after an EUS revealing persistent inflammation (86% versus 0%), and the patients were more likely to have a biologic initiated or changed (57% versus 0%). Among all subjects who underwent seton placement, time from seton removal to recurrence was longer for those followed by EUS compared to those followed by physical exam only; however, we were not powered to test for statistical significance. Conclusions: EUS to guide the combined medical and surgical management of PCD is feasible in the pediatric population. Larger prospective studies are needed to determine if EUS-directed management improves outcomes in pediatric patients with PCD.

AB - Background: Perianal fistulas are a debilitating manifestation of Crohn's disease (CD) in the pediatric population and present a management challenge. The aims of this study were to describe our experience using endoscopic ultrasound (EUS) to guide management of perianal CD (PCD) in a pediatric population, and determine whether using EUS to monitor healing after seton placement improves outcomes. Methods: We conducted a retrospective study of 2 cohorts: pediatric subjects with PCD who underwent EUS and pediatric subjects who underwent seton placement between 2002 and 2007. Results: In all, 25 children underwent a total of 42 EUS procedures. Of 28 EUSs performed to evaluate suspected perianal disease, complex fistulizing disease was identified in 15 (54%). Setons were placed after most EUSs demonstrating complex fistulizing disease and after none demonstrating superficial or no fistulizing disease. Of 14 EUSs performed to monitor healing around a seton, 7 (50%) demonstrated persistent peri-seton inflammation. Setons were more often left in place after an EUS revealing persistent inflammation (86% versus 0%), and the patients were more likely to have a biologic initiated or changed (57% versus 0%). Among all subjects who underwent seton placement, time from seton removal to recurrence was longer for those followed by EUS compared to those followed by physical exam only; however, we were not powered to test for statistical significance. Conclusions: EUS to guide the combined medical and surgical management of PCD is feasible in the pediatric population. Larger prospective studies are needed to determine if EUS-directed management improves outcomes in pediatric patients with PCD.

KW - Crohn's disease

KW - Endosonography

KW - Fistula

KW - Pediatrics

UR - http://www.scopus.com/inward/record.url?scp=77149129940&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77149129940&partnerID=8YFLogxK

U2 - 10.1002/ibd.21067

DO - 10.1002/ibd.21067

M3 - Article

C2 - 19637325

AN - SCOPUS:77149129940

VL - 16

SP - 461

EP - 468

JO - Inflammatory Bowel Diseases

JF - Inflammatory Bowel Diseases

SN - 1078-0998

IS - 3

ER -