Meta Analysis Of Early Surgical Intervention Versus Medical Therapy In Patients With Ileocolonic Crohn’s Disease

Background:For localized ileocolonic Crohn’s disease,surgical resection may be a better option than drug therapy,even in the age of biologics.Objective:To compare the curative effect of early surgical intervention and drug therapy for ileocolonic Crohn’s disease.Methods:The efficacy of early surgical treatment（resection of diseased bowel within 1 year after diagnosis）and medical therapy（including biologics,immunosuppressants,glucocorticoids,non-steroidalanti-inflammatory drugs,etc）in patients with ileocolonic crohn’s disease were systematically searched by using the combination of subject words and free words.Overall recurrence rate（clinical and/or endoscopic recurrence）was the primary endpoint,and biologics,immunosuppressants,and glucocorticoid use were the secondary endpoint.Odds ratio（OR）was used to compare dichotomous variables,and p<0.05 was considered statistically significant.Meanwhile,publication bias was evaluated by funnel plot.For included retrospective cohort studies,the Newcastle Ottawa Scale（NOS）was used for quality evaluation,and cochrane manual for quality evaluation of randomized controlled trials.Results:A total of 1997 patients were included in 8 literatures that met the inclusion criteria,including 650（32.5%）who received early surgical treatment and 1347（67.5%）who received medical treatment at the beginning and underwent surgical treatment during the course of disease or due to complications.NOS was used for scoring,with all studies scoring 6 or above.For ileocolonic Crohn’s disease early surgery was associated with a lower recurrence rate compared with drug therapy（OR 0.47;p value is 0.0005;95%CI[0.31,0.72]）,low utilization rate of biologics(OR,0.36;p<0.00001;95%CI[0.23,0.56]and immunosuppressive use rate（OR,0.60;95%CI[0.43,0.81];p,0.001）.However,there was no significant difference in glucocorticoid use between the two groups.Conclusion:Early surgery is associated with low recurrence rate,low biologic exposure,and low immunosuppressive exposure.Surgical treatment is a reasonable alternative to medical therapy in ileocolonic Crohn’s disease patients.