The following is a summary of “Temporary Faecal Diversion for Refractory Perianal and/or Distal Colonic Crohn’s Disease in the Biologic Era: An Updated Systematic Review with Meta-analysis,” published in the September 2023 issue of Gastroenterology by Jew et al.

Researchers started a retrospective study to evaluate the short- and long-term effectiveness of temporary fecal diversion (FD) in managing patients with refractory Crohn’s disease (CD), mainly focusing on outcomes achieved in the era of biologic therapy.

They conducted a systematic literature review (March 15, 2023), identifying 33 studies, with 19 shown in the biologic era, evaluating 1,578 patients with perianal and/or distal colonic CD who underwent temporary FD, aiming to restore bowel continuity. Long-term outcomes were reported, with the primary outcome being a successful restoration of bowel continuity, defined as remaining ostomy-free after reconnection for a minimum of 6 months after diversion or at the end of follow-up. Pooled rates (with 95% CI) were calculated using random effects meta-analysis, and factors associated with successful restoration of bowel continuity were examined.

The results showed that 61% of patients (with a 95% CI of 52-68%; 50% in the biologic era) experienced clinical improvement following FD. Stoma takedown was attempted in 34% of patients (with a range of 28–41%; 37% in the biologic era) within 6–18 months after diversion. Among those where bowel restoration was attempted, 63% of patients (54–71%) achieved successful restoration of bowel continuity, while 26% (20–34%) required re-diversion. Overall, 21% of patients (with a range of 17–27%; 24% in the biologic era) who underwent FD were successfully restored, and 34% of patients (with a range of 30–39%; 31% in the biologic era) required proctectomy with a permanent ostomy. In recent studies, post-diversion biologic use and proctitis absence correlated with successful bowel restoration after temporary FD.

Investigators concluded that biologic-era temporary diversion halved symptom improvement and restored bowel continuity in a quarter of patients with severe CD.

Source: academic.oup.com/ecco-jcc/article-abstract/18/3/375/7273762