Lauren Schwartz, Matthew Suh, Thomas Schiano, Christine Chamberlain, Hiroshi Sogawa, Kishore Iyer

Department of Intestinal Transplantation, Mount Sinai Hospital, New York, NY, United States

Background: Crohn’s disease (CD) accounts for 9 to18% of adult short bowel syndrome (SBS) and 8% of intestinal transplants (ITx). We review outcomes of intestinal rehabilitation (IR) and ITx in patients with CD.

Methods: We reviewed records of patients with SBS due to CD focusing on bowel anatomy, inflammatory activity, parenteral nutrition (PN) dependence and weaning, need for surgery or ITx, and outcomes. 

Results: 24 of 238 (10%) intestinal failure patients over a 4-year period had SBS due to CD.  All but 1 had clinically quiescent CD, and 6 were on immunomodulators.  11 patients were considered “stable” IR candidates.  2 of the 11 weaned off PN following enterocutaneous fistula (ECF) repairs. 3 additional patients had PN reductions.  Both patients who achieved full enteral autonomy retained partial colon whereas most patients who remained PN dependent or required ITx (n=19) had an end ostomy.  7 patients underwent surgery to improve bowel function including 4 ECF repairs, 3 reverse segment procedures, and 1 resection of strictured small bowel.  4 of the surgical patients went on to require ITx evaluations. 6 patients were transplanted and 2 await ITx. 2 additional patients opted against ITx, 1 patient was too ill for ITx, and 1 patient died.  Of the 6 ITx patients, 4 patients are alive with functional grafts off PN.  2 patients died post ITx due to infectious complications; 1of the 2 developed recurrent ECF without evidence of recurrent CD.

Conclusions: 45% of stable patients with SBS from CD were partially or fully weaned from PN, suggesting potential for IR.  Surgery to correct ECF helped wean TPN; reverse segments appeared ineffective.  ITx was indicated in over 50% of patients, but was only pursued in 25% due to medical instability or patient preference.  Patient and graft survivals of 67% suggest comparable risk to other causes of SBS.