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Crohn Disease: HELP
Articles by Amy Lee Lightner
Based on 40 articles published since 2010
(Why 40 articles?)
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Between 2010 and 2020, A. Lightner wrote the following 40 articles about Crohn Disease.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial The Present State and Future Direction of Regenerative Medicine for Perianal Crohn's Disease. 2019

Lightner, Amy L. ·Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, Ohio. Electronic address: Lightna@ccf.org. ·Gastroenterology · Pubmed #31034831.

ABSTRACT: -- No abstract --

2 Review Surgery for Inflammatory Bowel Disease in the Era of Biologics. 2020

Lightner, Amy Lee. ·Department of Colorectal Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. Lightna@ccf.org. ·J Gastrointest Surg · Pubmed #32253646.

ABSTRACT: INTRODUCTION: The advent of monoclonal antibody therapy for the treatment of inflammatory bowel disease has greatly changed the multidisciplinary management of these patients, including surgical approaches. As an increasing number of inflammatory bowel disease patients are being medically managed with monoclonal antibody therapy or combination therapy with immunomodulators, more patients are coming to the operating room having been exposed to these medical therapies. METHODS: A search of the relevant literature regarding monoclonal antibody therapy and postoperative outcomes was performed. RESULTS: Significant controversy remains regarding the association between monoclonal antibodies and postoperative outcomes. Different classes of monoclonal antibodies may have different impacts on infectious complications. Operations for Crohn's disease and ulcerative colitis alter how we think about a change in care in the era of monoclonal antibodies. CONCLUSION: In Crohn's disease, intestinal diversion may be considered in patient and disease specific scenarios and in ulcerative colitis, the use of a 3-stage approach to an ileal pouch is now more often used.

3 Review Perioperative and Postoperative Management of Patients With Crohn's Disease and Ulcerative Colitis. 2020

Barnes, Edward L / Lightner, Amy L / Regueiro, Miguel. ·Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Multidisciplinary Center for Inflammatory Bowel Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: edward_barnes@med.unc.edu. · Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio. · Department of Gastroenterology, Hepatology, and Nutrition, The Pier C. and Renee A. Borra Family Endowed Chair in Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio; Digestive Disease and Surgery Institute, Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio. ·Clin Gastroenterol Hepatol · Pubmed #31589972.

ABSTRACT: Although the number of available therapies for the treatment of ulcerative colitis and Crohn's disease (CD) continues to expand, a significant portion of patients with inflammatory bowel disease will require surgical intervention. Surgery remains an integral part of the treatment algorithm for patients with ulcerative colitis and CD, and thus multidisciplinary approaches to the perioperative and postoperative management of patients with inflammatory bowel disease are critical to improving outcomes during these periods. New mechanisms of biologic therapies are emerging and new treatment strategies focused on earlier and potentially more aggressive use of immunosuppressive therapies are advocated in the current treatment era. In this review, we outline multidisciplinary strategies for the preoperative management of immunosuppressive therapies, including a discussion of the most recent evidence regarding the safety of biologic therapy in the preoperative period. We also discuss the postoperative medical management of patients undergoing intestinal resection for CD, with a particular focus on risk stratification and appropriate therapy selection in the immediate postoperative setting. Finally, we review potential postoperative complications after restorative proctocolectomy with ileal pouch-anal anastomosis and their management.

4 Review Preoperative Considerations in Inflammatory Bowel Disease. 2019

McKenna, Nicholas P / Lightner, Amy L. ·Department of Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. · Digestive Diseases Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: lightna@ccf.org. ·Surg Clin North Am · Pubmed #31676049.

ABSTRACT: Patients with ulcerative colitis and Crohn's disease often present to surgery malnourished and on combination immunosuppression. These factors affect operation selection and postoperative outcomes. Corticosteroids have a well-established detrimental effect on postoperative outcomes, whereas the impact of biologic agents is more controversial. In a patient exposed to these medications, and in the presence of other risk factors, temporary intestinal diversion is likely the best choice. Enteral nutrition may help optimize malnourished patients at high risk of adverse postoperative outcomes.

5 Review Mesenchymal Stem Cells for Perianal Crohn's Disease. 2019

Carvello, Michele / Lightner, Amy / Yamamoto, Takayuki / Kotze, Paulo Gustavo / Spinelli, Antonino. ·Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, 20089 Rozzano, Italy. · Department of Colon and Rectal Surgery, Cleveland Clinic, Cleveland, OH 44195, USA. · Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Mie 510-0016, Japan. · Colorectal Surgery Unit, Cajuru University Hospital, Catholic University of Paraná, Curitiba 80215-901, Brazil. · Colon and Rectal Surgery Unit, Humanitas Clinical and Research Center, 20089 Rozzano, Italy. antonino.spinelli@humanitas.it. · Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy. antonino.spinelli@humanitas.it. ·Cells · Pubmed #31340546.

ABSTRACT: Perianal fistulizing Crohn's disease (PFCD) is associated with significant morbidity and might negatively impact the quality of life of CD patients. In the last two decades, the management of PFCD has evolved in terms of the multidisciplinary approach involving gastroenterologists and colorectal surgeons. However, the highest fistula healing rates, even combining surgical and anti-TNF agents, reaches 50% of treated patients. More recently, the administration of mesenchymal stem cells (MSCs) have shown notable promising results in the treatment of PFCD. The aim of this review is to describe the rationale and the possible mechanism of action of MSC application for PFCD and the most recent results of randomized clinical trials. Furthermore, the unmet needs of the current administration process and the expected next steps to improve the outcomes will be addressed.

6 Review Cell-based Therapy for Perianal Fistulising Crohn's Disease. 2019

Kotze, Paulo Gustavo / Spinelli, Antonino / Lightner, Amy Lee. ·Colorectal Surgery Unit, IBD outpatient clinics, Catholic University of Parana, Curitiba, Brazil. · Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Italy. · Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, United States. ·Curr Pharm Des · Pubmed #31092172.

ABSTRACT: BACKGROUND: The management of complex perianal fistulas in Crohn's disease (CD) represents a challenge for patients, gastroenterologists and colorectal surgeons. There are clear limitations with current medical and surgical options, and healing rates remain far from what is expected. A multidisciplinary approach with optimized medical therapy, usually anti-TNF agents, associated with setons and additional surgical techniques is currently the best strategy to aim fistula healing. METHODS: A comprehensive review of the literature was conducted on the use of mesenchymal stem cells (MSCs). RESULTS: The use of mesenchymal stem cells (MSCs) has recently emerged as a promising new therapeutic strategy for complex fistulas in CD patients. This review summarizes the evidence of the use of MSCs in complex CD fistulas, by exploring in detail the types of cells that can be used and their modes of delivery. Additionally, the results of the most recent phase III randomized trial with local MSCs injection are described, and future challenges of this therapeutic option are discussed. CONCLUSION: The use of MSCs represents hope for better outcomes in patients with CD-related perianal fistulas. More research in the field will help to position this specific therapy in treatment algorithms.

7 Review Stem Cell Therapies for Inflammatory Bowel Disease. 2019

Lightner, Amy L. ·Department of Colon and Rectal Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA. lightna@ccf.org. ·Curr Gastroenterol Rep · Pubmed #30955111.

ABSTRACT: PURPOSE OF REVIEW: Stem cell therapies have demonstrated safety and efficacy in the treatment of perianal Crohn's disease as compared to conventional therapy. Thus, an understanding of their place in the treatment algorithm for inflammatory bowel disease has become imperative as we move into an era of regenerative medicine. RECENT FINDINGS: There have now been over a dozen clinical trials highlighting stem cells as a useful therapeutic in Crohn's disease. Due to the success in the local treatment for perianal Crohn's disease, investigation is continuing in the space of targeted systemic delivery for the treatment of luminal disease. As we increase the number of patients treated in clinical trials, it is imperative to define the optimal cell donor, optimize treatment dosing and retreatment protocols, and understand methods for safely targeting and treating intraluminal disease.

8 Review A Systematic Review and Meta-analysis of Mesenchymal Stem Cell Injections for the Treatment of Perianal Crohn's Disease: Progress Made and Future Directions. 2018

Lightner, Amy L / Wang, Zhen / Zubair, Abba C / Dozois, Eric J. ·Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota. · Division of Health Care Policy and Research, Mayo Clinic, Rochester, Minnesota. · Division of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, Florida. ·Dis Colon Rectum · Pubmed #29578916.

ABSTRACT: BACKGROUND: There has been a surge in clinical trials studying the safety and efficacy of mesenchymal stem cells for the treatment of perianal Crohn's disease. OBJECTIVE: The purpose of this work was to systematically review the literature to determine safety and efficacy of mesenchymal stem cells for the treatment of refractory perianal Crohn's disease. DATA SOURCES: Sources included PubMed, Cochrane Library Central Register of Controlled Trials, and Embase. STUDY SELECTION: Studies that reported safety and/or efficacy of mesenchymal stem cells for the treatment of perianal Crohn's disease were included. Two independent assessors reviewed eligible articles. INTERVENTION: The study intervention was delivery of mesenchymal stem cells to treat perianal Crohn's disease. MAIN OUTCOMES MEASURES: Safety and efficacy of mesenchymal stem cells used to treat perianal Crohn's disease were measured. RESULTS: Eleven studies met the inclusion criteria and were included in the systematic review. Three trials with a comparison arm were included in the meta-analysis. There were no significant increases in adverse events (OR = 1.07 (95% CI, 0.61-1.89); p = 0.81) or serious adverse events (OR = 0.53 (95% CI, 0.28-0.98); p = 0.04) in patients treated with mesenchymal stem cells. Mesenchymal stem cells were associated with improved healing as compared with control subjects at primary end points of 6 to 24 weeks (OR = 3.06 (95% CI, 1.05-8.90); p = 0.04) and 24 to 52 weeks (OR = 2.37 (95% CI, 0.90-6.25); p = 0.08). LIMITATIONS: The study was limited by its multiple centers and heterogeneity in the study inclusion criteria, mesenchymal stem cell origin, dose and frequency of delivery, use of scaffolding, and definition and time point of fistula healing. CONCLUSIONS: Although there have been only 3 trials conducted with control arms, existing data demonstrate improved efficacy and no increase in adverse or serious adverse events with mesenchymal stem cells as compared with control subjects for the treatment of perianal Crohn's disease.

9 Review Duodenal Crohn's Disease. 2018

Lightner, Amy L. ·Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota. ·Inflamm Bowel Dis · Pubmed #29462397.

ABSTRACT: Symptomatic duodenal Crohn's disease (CD) is an uncommon disease presentation, especially in isolation. The most common duodenal disease phenotype is stricturing disease rather than inflammatory or perforating. Most patients are asymptomatic and are therefore diagnosed incidentally by cross-sectional imaging or endoscopy. Medical management includes proton pump inhibitor therapy and immunosuppressive therapy including corticosteroids, immunomodulatory therapy, and biologic therapy. Symptomatic strictures can often be treated medically or endoscopically, and do not always require surgery. Surgical options include resection with primary anastomosis, bypass with a gastrojejunostomy, and strictureplasty. Treatment recommendations are largely based on limited evidence from small series and expert opinion. Therefore, the optimal treatment algorithm remains largely subjective and undefined.

10 Review Segmental Resection versus Total Proctocolectomy for Crohn's Colitis: What is the Best Operation in the Setting of Medically Refractory Disease or Dysplasia? 2018

Lightner, Amy L. ·Department of Colon and Rectal Surgery, Mayo Clinic, Rochester MN. ·Inflamm Bowel Dis · Pubmed #29462390.

ABSTRACT: Crohn's disease (CD) may affect any part of the gastrointestinal tract. When isolated to the colon, and patients become medically refractory, there are several surgical options - segmental resection, subtotal colectomy with ileorectal anastomosis, or a total proctocolectomy and end ileostomy. Unfortunately, surgery does not cure CD, and, regardless of the extent of bowel removed, recurrence may be seen in the small bowel. This may lead to need for further immunosuppression or surgery. Therefore, when appropriate, a segmental colectomy or subtotal colectomy may prevent a permanent ostomy required with a total proctocolectomy. In the setting of dysplasia identified on colonoscopy, low quality evidence guides our treatment paradigms. Even though identification of dysplasia has greatly improved with chromoendoscopy, rates of synchronous or metachronous neoplasm remain high. Thus, a total proctocolectomy and end ileostomy, whereas a larger operation, may be best for the patient to remove all at risk tissue. Further research with prospective or randomized control trials is needed to improve our practice guidelines of both scenarios.

11 Review Modern management of perianal fistulas in Crohn's disease: future directions. 2018

Kotze, Paulo Gustavo / Shen, Bo / Lightner, Amy / Yamamoto, Takayuki / Spinelli, Antonino / Ghosh, Subrata / Panaccione, Remo. ·Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada. · Interventional IBD Unit, Cleveland Clinic Foundation, Cleveland, Ohio, USA. · Division of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA. · IBD Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan. · Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Italy. · Institute of Translational Medicine, University of Birmingham, Birmingham, UK. ·Gut · Pubmed #29331943.

ABSTRACT: Perianal fistulae in patients with Crohn's disease (CD) can be associated with significant morbidity resulting in negative impact on quality of life. The last two decades have seen significant advancements in the management of perianal fistulas in CD, which has evolved into a multidisciplinary approach that includes gastroenterologists, colorectal surgeons, endoscopists and radiologists. Despite the introduction of new medical therapies such as antitumour necrosis factor and novel models of care delivery, the best fistula healing rates reported with combined medical and surgical approaches are approximately 50%. More recently, newer biologics, cell-based therapies as well as novel endoscopic and surgical techniques have been introduced raising new hopes that outcomes can be improved upon. In this review, we describe the modern management and the most recent advances in the management of complex perianal fistulising CD, which will likely impact clinical practice. We will explore optimal use of both older and newer biological agents, as well as new data on cell-based therapies. In addition, new techniques in endoscopic and surgical approaches will be discussed.

12 Review Interdisciplinary Management of Perianal Crohn's Disease. 2017

Lightner, Amy L / Faubion, William A / Fletcher, Joel G. ·Division of Colon and Rectal Surgery, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. Electronic address: Lightner.amy@mayo.edu. · Division of Gastroenterology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. · Division of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55905, USA. ·Gastroenterol Clin North Am · Pubmed #28838414.

ABSTRACT: Perianal disease is a common manifestation of Crohn disease (CD) that results in significant morbidity and decreased quality of life. Despite several medical and surgical options, complex perianal CD remains difficult to treat. Before the advent of biologic therapy, antibiotics were the mainstay of medical treatment. Infliximab remains the most well-studied medical therapy for perianal disease. Surgical interventions are limited by the risk of nonhealing wounds and potential incontinence. When treatment options fail, fecal diversion or proctectomy may be necessary. Stem cell therapies may offer improved results and seem to be safe, but are not yet widely used.

13 Review Mesenchymal Stem Cell Injections for the Treatment of Perianal Crohn's Disease: What We Have Accomplished and What We Still Need to Do. 2017

Lightner, Amy L / Faubion, William A. ·Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA. · Division of Gastroenterology, Mayo Clinic, Rochester, MN, USA. ·J Crohns Colitis · Pubmed #28387832.

ABSTRACT: Perianal Crohn's disease [CD] is found in a quarter of patients with CD and remains notoriously difficult to treat. Several medical and surgical therapies are available. However, none is particularly effective nor reliably provides sustained remission. In addition, surgical intervention is complicated by poor healing and the potential for incontinence. Mesenchymal stem cell-based therapies provide a promising treatment alternative for perianal CD, with demonstrated safety, improved efficacy, and a decreased side effect profile. Several phase I, II, and now III randomised controlled trials have now reported safety and efficacy in treating perianal CD. The aim of this review is to discusses the outcomes of conventional treatment approaches, outcomes of mesenchymal stem cell therapies, considerations specific to stem cell-based therapies, and future directions for research.

14 Review Crohn's Disease of the Ileoanal Pouch. 2016

Lightner, Amy L / Pemberton, John H / Loftus, Edward J. ·*Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota; and †Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. ·Inflamm Bowel Dis · Pubmed #27057684.

ABSTRACT: Crohn's disease (CD) of the pouch is an increasingly recognized diagnosis after ileal pouch-anal anastomosis. This post-ileal pouch-anal anastomosis diagnosis in conjunction with pouchitis remains the leading reason for pouch excision. Unfortunately, CD of the pouch remains a difficult diagnosis with lack of a uniform definition largely because of its similarity to common postoperative pouch complications, including pouchitis, abscess formation, or stricture at the anastomosis. Once diagnosed, treatment algorithms largely include multimodal therapy including biologics. This review focuses on the definition, etiology, diagnosis, and treatment for CD of the pouch, a postoperative de novo diagnosis of CD.

15 Clinical Trial Autologous Mesenchymal Stem Cells, Applied in a Bioabsorbable Matrix, for Treatment of Perianal Fistulas in Patients With Crohn's Disease. 2017

Dietz, Allan B / Dozois, Eric J / Fletcher, Joel G / Butler, Greg W / Radel, Darcie / Lightner, Amy L / Dave, Maneesh / Friton, Jessica / Nair, Asha / Camilleri, Emily T / Dudakovic, Amel / van Wijnen, Andre J / Faubion, William A. ·Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. Electronic address: dietz.allan@mayo.edu. · Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota. · Department of Radiology, Mayo Clinic, Rochester, Minnesota. · Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota. · Division of Gastroenterology and Liver Disease, Case Western Reserve University School of Medicine, Cleveland, Ohio. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. · Department of Biomedical Statistics and Information, Mayo Clinic, Rochester, Minnesota. · Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. Electronic address: faubion.william@mayo.edu. ·Gastroenterology · Pubmed #28400193.

ABSTRACT: In patients with Crohn's disease, perianal fistulas recur frequently, causing substantial morbidity. We performed a 12-patient, 6-month, phase 1 trial to determine whether autologous mesenchymal stem cells, applied in a bioabsorbable matrix, can heal the fistula. Fistula repair was not associated with any serious adverse events related to mesenchymal stem cells or plug placement. At 6 months, 10 of 12 patients (83%) had complete clinical healing and radiographic markers of response. We found placement of mesenchymal stem cell-coated matrix fistula plugs in 12 patients with chronic perianal fistulas to be safe and lead to clinical healing and radiographic response in 10 patients. ClinicalTrials.gov Identifier: NCT01915927.

16 Article Perianal fistula and the ileoanal pouch - different aetiologies require distinct evaluation. 2020

Reza, L M / Lung, P F C / Lightner, A L / Hart, A L / Clark, S K / Tozer, P J. ·Fistula Research Unit, St Mark's Hospital and Academic Institute, London, UK. · St Mark's Hospital and Academic Institute, London, UK. · Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK. · Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA. ·Colorectal Dis · Pubmed #32304181.

ABSTRACT: AIM: Restorative proctocolectomy has been widely adopted as the procedure of choice for restoring gastrointestinal continuity following proctocolectomy. It is often associated with improved quality of life and high patient satisfaction; however, the development of a pouch anal fistula can cause significant morbidity. Pouch fistulas are notoriously difficult to treat and there is great heterogeneity in the management reported of these fistulas. A lack of classification, and the assumption that fistulas originating from completely different aetiologies will behave and respond similarly to a particular treatment strategy, precludes meaningful comparison of management outcomes. We aim to introduce consistency in the reporting of pouch fistulas using a novel classification system. METHODS: A consensus process involving clinicians experienced in the management of pouch fistulas from two high volume tertiary centres was performed. RESULTS: We propose that pouch anal fistulas should be classified into four distinct groups according to their aetiology: group 1, anastomotic related; group 2, inflammatory bowel disease related, with sub-classifications Crohn's (type A) and non-Crohn's (type B) in origin; group 3, cryptoglandular related; and group 4, malignancy related. CONCLUSION: Classification of pouch fistulas according to their aetiology will provide consistency in the literature and improve the quality of prospective evidence for the management of pouch fistulas.

17 Article Matrix-Delivered Autologous Mesenchymal Stem Cell Therapy for Refractory Rectovaginal Crohn's Fistulas. 2020

Lightner, Amy L / Dozois, Eric J / Dietz, Allan B / Fletcher, Joel G / Friton, Jessica / Butler, Greg / Faubion, William A. ·Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio, USA. · Division of Colon and Rectal Surgery, Rochester, Minnesota, USA. · IMPACT Lab, Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, Rochester, Minnesota, USA. · Department of Radiology, Rochester, Minnesota, USA. · Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA. ·Inflamm Bowel Dis · Pubmed #31605115.

ABSTRACT: BACKGROUND: Crohn's rectovaginal fistulizing disease remains notoriously difficult to treat. A phase I clinical trial to evaluate the safety and feasibility of a novel protocol using a mesenchymal stem cell (MSC)-coated Gore Bio-A fistula plug for the treatment of medically and surgically refractory Crohn's rectovaginal fistulas was conducted. METHODS: Five patients underwent an autologous subcutaneous adipose tissue harvest via a 2-cm abdominal wall incision at time of exam under anesthesia (EUA) with seton placement. MSCs were isolated, expanded, and impregnated on the plug. After 6 weeks, patients returned to the operating room for placement of the MSC-coated plug. The primary end points were safety and feasibility; the secondary end point was clinical and radiographic healing at 6 months. RESULTS: Five female patients (median age [range], 49 [38-53] years) with a median disease duration (range) of 23 (7-34) years who were on biologic (n = 5) or combination therapy (n = 3) had successful harvest and expansion of MSCs and delivery of the Gore Bio-A plug. There were no serious adverse events or adverse events related to the MSCs or plug during the 6-month follow-up. At 6 months, 3 patients had complete cessation of drainage, and 2 had >50% reduction in drainage; all had a persistent fistula tract identified on magnetic resonance imaging and EUA at 6 months. CONCLUSIONS: Surgical placement of an autologous adipose-derived MSC-coated fistula plug in diverted patients with Crohn's rectovaginal fistulas was safe and feasible. All patients had a reduction in the size of their fistula tract, and 3 of 5 had cessation of drainage, but none achieved complete healing.This was a phase I clinical trial of autologous mesenchymal stem cells on a plug for rectovaginal Crohn's fistulas.

18 Article Excisional Hemorrhoidectomy: Safe in Patients With Crohn's Disease? 2019

Lightner, Amy L / Kearney, David / Giugliano, Danica / Hull, Tracy / Holubar, Stefan D / Koh, Sharon / Zaghiyan, Karen / Fleshner, Phillip R. ·Department of Colorectal Surgery, Digestive Disease Surgical Institute, Cleveland Clinic, Cleveland, OH. · Division of Colon and Rectal Surgery, Cedars-Sinai Medical Center, Los Angeles, CA. ·Inflamm Bowel Dis · Pubmed #31633186.

ABSTRACT: INTRODUCTION: Due to concerns over wound healing, hemorrhoidectomy in patients with Crohn's disease (CD) remains controversial. We sought to ascertain safety and efficacy of excisional hemorrhoidectomy in CD. METHODS: A retrospective review of all adult CD patients undergoing excisional hemorrhoidectomy between January 1, 1995, and January 1, 2019, at 2 IBD referral centers was performed. Data collected included patient demographics, clinical characteristics of CD (anorectal symptoms; prior nonoperative hemorrhoidal therapy; presence of other perianal disease; and activity, duration, and anatomic location of CD), and postoperative complications including bleeding, wound healing, and need for further therapy or surgical intervention after surgery. RESULTS: A total of 36 adult patients with Crohn's disease with symptomatic hemorrhoidal disease were included. The study cohort included 16 males (44%), and median age was 49 (range, 21 to 77) years. Predominant symptoms included pain (n = 16; 44%), prolapse (n = 8; 22%), and bleeding (n = 12; 33%). Sixteen patients (44%) had nonoperative therapy before surgery. Twenty-four patients (67%) had other perianal disease. At the time of hemorrhoidectomy, 9 patients (25%) were exposed to corticosteroids, 8 patients (25%) to immunomodulators, and 9 patients (25%) to biologics. During a median follow-up time of 31.5 (range, 1 to 255) months after hemorrhoidectomy, 4 patients (11%) had complications (1 developed a stricture, 1 developed a perianal abscess/fistula, 1 had a nonhealing wound, and 1 had hemorrhoidal recurrence). CONCLUSION: Our data suggest that excisional hemorrhoidectomy may be performed safely in CD patients who have failed nonoperative hemorrhoidal therapy without concern for de novo perianal disease or need for proctectomy.Hemorrhoidal disease is common in patients with Crohn's disease. This study sought to understand the outcomes of surgically treating hemorrhoids in patients with Crohn's disease.

19 Article Hemorrhoidectomy and Excision of Skin Tags in IBD: Harbinger of Doom or Simply a Disease Running Its Course? 2019

McKenna, Nicholas P / Lightner, Amy L / Habermann, Elizabeth B / Mathis, Kellie L. ·Department of Surgery, Mayo Clinic, Rochester, Minnesota. · The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota. · Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota. ·Dis Colon Rectum · Pubmed #31580261.

ABSTRACT: BACKGROUND: Controversy in performing hemorrhoidectomy and anal skin tag excision in patients with IBD stems from dated reports of nonhealing wounds resulting in proctectomy. OBJECTIVE: This study aimed to determine the safety of interventional management of hemorrhoids or anal skin tags in patients with Crohn's disease or ulcerative colitis. DESIGN: This study is a retrospective review of patient records from 2000 to 2017. SETTING: The patient records were retrieved from a multistate health system. PATIENTS: Adult patients with IBD undergoing interventional management of hemorrhoids or skin tags were included. MAIN OUTCOME MEASURE: The primary outcome measured was the long-term requirement of proctectomy. RESULTS: Ninety-seven patients (n = 49 Crohn's disease, 48 ulcerative colitis) underwent interventional management of hemorrhoids or anal skin tags (n =35 rubber band ligation, 27 anal skin tag excision, 21 hemorrhoidectomy, 14 excision/incision of thrombosed hemorrhoid). Thirty-day complications were observed in 5 patients (n = 4 urinary retention, 1 perianal abscess). Five patients with Crohn's disease eventually required proctectomy at a median of 7 years after skin tag excision (range, 6 months to 10 years), but none were secondary to impaired wound healing. Two patients with ulcerative colitis who had previously undergone IPAA were subsequently diagnosed with Crohn's disease of the pouch after skin tag excision. No other long-term complications were seen in patients with ulcerative colitis. LIMITATIONS: The study's retrospective design does not allow identification of patients with IBD who underwent only medical management of their hemorrhoids. There is also selection bias in which patients were selected for interventional management of their disease. CONCLUSIONS: The requirement for proctectomy after hemorrhoidectomy/skin tag excision appears to be secondary to the natural disease course of perianal Crohn's disease rather than perianal intervention. Selective hemorrhoidectomy and skin tag excision in patients with well-controlled luminal disease should be considered. See Video Abstract at http://links.lww.com/DCR/B55. HEMORROIDECTOMÍA ASOCIADA A LA EXCISIÓN DE PLICOMAS EN CASOS DE ENFERMEDAD INFLAMATORIA INTESTINAL: ¿ANUNCIO DE FATALIDAD O SIMPLEMENTE EVOLUCIÓN NATURAL DE LA ENFERMEDAD?: Está controvertida la realización de una hemorroidectomía asociada a la excisión de plicomas ano-cutáneos en pacientes con enfermedad inflamatoria intestinal, así lo han demostrado informes detallados sobre la no cicatrisación de las heridas conllevando a una proctectomía.Determinar los margenes de seguridad en casos de tratamiento instrumental de hemorroides asociadas a la excisión de plicomas ano-cutáneos en pacientes portadores de colitis ulcerosa o enfermedad de Crohn.Revisión retrospectiva de historias clinicas de pacientes entre 2000 y 2017.Servicio Multiestatal de Salud.Adultos con enfermedad inflamatoria intestinal sometidos a tratamiento instrumental de hemorroides asociado a la excisión de plicomas ano-cutáneos.Requisitos a largo plazo para una proctectomía.Noventa y siete pacientes (49 con enfermedad de Crohn, 48 con colitis ulcerosa) se sometieron a un tratamiento instrumental de hemorroides asociada a la excisión de plicomas ano-cutáneos (35 ligadura con bandas elásticas, 27 excisión de plicomas ano-cutáneos, 21 hemorroidectomías, 14 excisiones / incisiones de hemorroides trombosadas) Se observaron complicaciones a los 30 días en cinco pacientes (4 con retención urinaria, 1 absceso perianal). Cinco pacientes con enfermedad de Crohn requirieron proctectomía en una media de 7 años después de la excisión de los plicomas ano-cutáneos (rango, 6 meses a 10 años), pero ninguno fue secundario a la mala cicatrización de la herida. Dos pacientes con colitis ulcerosa que previamente se habían sometido a una anastomosis colo-anal protegia por ilestomía fueron diagnosticados posteriormente con enfermedad de Crohn localizada en la ostomía después de la excisión de plicomas ano-cutáneos. No se observaron complicaciones a largo plazo en pacientes con colitis ulcerosa.El diseño retrospectivo del estudio no permite la identificación de pacientes con enfermedad inflamatoria intestinal que se sometieron únicamente al tratamiento médico de las hemorroides. También existe un sesgo de selección de pacientes escogidos para tratamiento instrumental de la enfermedad hemorroidaria.El requisito de proctectomía después de la hemorroidectomía / excisión de plicomas anocutáneos parece ser secundario al curso de la enfermedad natural de la enfermedad de Crohn perianal en el sitio de la intervención perianal. Se debe considerar la hemorroidectomía selectiva y la excisión de plicomas ano-cutáneos solo en pacientes con enfermedad endoluminal controlada. Vea el video del resumen en http://links.lww.com/DCR/B55.

20 Article Biologics and 30-Day Postoperative Complications After Abdominal Operations for Crohn's Disease: Are There Differences in the Safety Profiles? 2019

Lightner, Amy L / McKenna, Nicholas P / Alsughayer, Ahmad / Harmsen, William S / Taparra, Kekoa / Parker, Maile E / Raffals, Laura E / Loftus, Edward V. ·Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota. · Department of Colorectal Surgery, Cleveland Clinic, Cleveland, Ohio. · Department of General Surgery, Mayo Clinic, Rochester, Minnesota. · Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota. · Mayo Medical School, Mayo Clinic, Rochester, Minnesota. · Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota. ·Dis Colon Rectum · Pubmed #31567927.

ABSTRACT: BACKGROUND: The evidence regarding the association of preoperative biologic exposure and postoperative outcomes remains controversial for both antitumor necrosis factor agents and vedolizumab and largely unknown for ustekinumab. OBJECTIVE: The purpose of this study was to determine differences in the rates of 30-day postoperative overall infectious complications and intra-abdominal septic complications among the 3 classes of biologic therapies as compared with no biologic therapy. DESIGN: This was a retrospective review. SETTINGS: The study was conducted at an IBD referral center. PATIENTS: Adult patients with Crohn's disease who received an antitumor necrosis factor, vedolizumab, ustekinumab, or no biologic therapy within 12 weeks of a major abdominal operation between May 20, 2014, and December 31, 2017, were included. MAIN OUTCOMES MEASURES: Thirty-day overall postoperative infectious complications and intra-abdominal septic complications were measured. RESULTS: A total of 712 patients with Crohn's disease were included; 272 patients were exposed to an antitumor necrosis factor agents, 127 to vedolizumab, 38 to ustekinumab, and 275 to no biologic therapy within the 12 weeks before an abdominal operation. Patients exposed to a biologic were more likely to be taking a concurrent immunomodulator, but there was no difference in concurrent corticosteroid usage. The particular class of biologic was not independently associated with total overall infectious complications. Vedolizumab was associated with an increased rate of intra-abdominal sepsis on univariate analysis but not on multivariable analysis. Combination immunosuppression was associated with both an increased rate of overall postoperative infectious complications and intra-abdominal sepsis. LIMITATIONS: The study was limited by its retrospective design and single-center data. CONCLUSIONS: The overall rate of total infectious complications or intra-abdominal septic complications was not increased based on preoperative exposure to a particular class of biologic. Rates increased with combination immunosuppression of biologic therapy with corticosteroids and previous abdominal resection. See Video Abstract at http://links.lww.com/DCR/B24. BIOLÓGICOS Y COMPLICACIONES POSTOPERATORIAS DE 30 DÍAS DESPUÉS DE LAS OPERACIONES ABDOMINALES PARA LA ENFERMEDAD DE CROHN: ¿EXISTEN DIFERENCIAS EN LOS PERFILES DE SEGURIDAD?:: La evidencia sobre la asociación de la exposición biológica preoperatoria y los resultados postoperatorios sigue siendo controvertida controversial tanto para los agentes del factor de necrosis tumoral (anti-TNF) como para el vedolizumab, y en gran parte desconocida para el ustekinumab.Determinar las diferencias en las tasas de complicaciones infecciosas generales postoperatorias de 30 días y complicaciones sépticas intraabdominales entre las tres clases de terapias biológicas en comparación con ninguna terapia biológica.Revisión retrospectiva.centro de referencia de la enfermedad inflamatoria intestinal.Pacientes adultos con enfermedad de Crohn que recibieron un factor de necrosis antitumoral, vedolizumab, ustekinumab o ningún tratamiento biológico dentro de las 12 semanas de una operación abdominal mayor entre el 5/20/2014 y el 12/31/2017.Complicaciones infecciosas postoperatorias generales de 30 días, complicaciones sépticas intraabdominales.Se incluyeron setecientos doce pacientes con enfermedad de Crohn; 272 pacientes fueron expuestos a un anti-TNF, 127 a vedolizumab, 38 a ustekinumab y 275 a ninguna terapia biológica dentro de las 12 semanas previas a una operación abdominal. Los pacientes expuestos a un producto biológico tenían más probabilidades de tomar un inmunomodulador concurrente, pero no hubo diferencias en el uso simultáneo de corticosteroides. La clase particular de productos biológicos no se asoció de forma independiente con las complicaciones infecciosas totales. Vedolizumab se asoció con una mayor tasa de sepsis intraabdominal en el análisis univariable, pero no en el análisis multivariable. La inmunosupresión combinada se asoció tanto con una mayor tasa de complicaciones infecciosas postoperatorias generales como con sepsis intraabdominal.Diseño retrospectivo, datos de centro único.La tasa general de complicaciones infecciosas totales o complicaciones sépticas intraabdominales no aumentó en función de la exposición preoperatoria a una clase particular de productos biológicos. Las tasas aumentaron con la combinación de inmunosupresión de la terapia biológica con corticosteroides y resección abdominal previa. Vea el Resumen del Video en http://links.lww.com/DCR/B24.

21 Article Risk factors for 90-day readmission and return to the operating room following abdominal operations for Crohn's disease. 2019

Grass, Fabian / Ansell, James / Petersen, Molly / Mathis, Kellie L / Lightner, Amy L. ·Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN; Department of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland. · Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN. · Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN. · Division of Colorectal Surgery, Cleveland Clinic, OH. Electronic address: Lightna@ccf.org. ·Surgery · Pubmed #31548096.

ABSTRACT: BACKGROUND: This study aimed to determine timing and risk factors for 30- and 90-day unplanned hospital readmissions and return to the operating room. METHODS: Retrospective case series, including consecutive adult patients with Crohn's disease, undergoing a major abdominal surgical procedure during a 3.5-year inclusion period was performed. The primary outcomes were 0- to 30-day and 30- to 90-day readmission and return to the operating room rates. Univariate and multivariable risk factors for both outcomes at 30 and 90 days were assessed through Cox regression analysis. RESULTS: Of 680 included patients with Crohn's disease, 89 (13.1%) were readmitted within 30 days, 55 (8.1%) within 30-90 days, and 11 (1.6%) in both follow-up periods for a combined 90-day readmission rate of 24.4% (n = 166). Multivariable risk factors for 30-day readmissions were type of procedure performed, corticosteroid use (hazard ratio [HR] 1.71, P = .01), younger age (HR 0.98 per year, P = .01), and prolonged disease duration (HR 1.03 per year, P = .03). No significant risk factors identified for 30- to 90-day readmissions. By 90 days, 76 patients (11.2%) had a return to the operating room (of which 8.8% was within 30 days). Risk factors for 30-day return to the operating room included tobacco use (HR 1.86, P = .04), diabetes (HR 3.30, P = .01), corticosteroid use (HR 3.51, P <.001), and preoperative immunomodulator therapy (HR 2.70, P < .001). CONCLUSION: Type of surgery, corticosteroid use, younger age, and prolonged disease duration were associated with 30-day hospital readmission, and tobacco use, diabetes, corticosteroid use, and preoperative immunomodulator therapy were risk factors for 30-day return to the operating room. Postoperative biologic therapy did not increase hospital readmission or return to operating room rates within 90 days of surgery.

22 Article Regenerative medicine for advanced surgical care. 2019

Lightner, A L. ·Department of Colorectal Surgery, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, 44195, USA. ·Br J Surg · Pubmed #31304583.

ABSTRACT: -- No abstract --

23 Article Body mass index: Implications on disease severity and postoperative complications in patients with Crohn's disease undergoing abdominal surgery. 2019

McKenna, Nicholas P / Habermann, Elizabeth B / Zielinski, Martin D / Lightner, Amy L / Mathis, Kellie L. ·Department of Surgery, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN. · Division of Trauma, Critical Care, and General Surgery, Mayo Clinic, Rochester, MN. · Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN. · Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN. Electronic address: mathis.kellie@mayo.edu. ·Surgery · Pubmed #31262567.

ABSTRACT: BACKGROUND: Obesity is increasing in prevalence among patients with Crohn's disease, but how body mass index affects disease severity and postoperative outcomes remains unknown. METHODS: A retrospective review of ileocolic resections for Crohn's disease performed at a single institution between January 2007 and December 2017 was conducted. On the day of surgery, patients were grouped by body mass index into underweight, normal weight, overweight, and obese categories. Intergroup comparisons and trend tests were performed on disease characteristics and postoperative outcomes. A multivariable model for superficial surgical site infection was constructed. RESULTS: A total of 758 patients were identified; 80 (11%) patients were underweight, 372 (49%) were normal weight, 178 (23%) were overweight, and 128 (17%) were obese. Both fistulizing Crohn's phenotype and preoperative immunosuppression occurred less frequently in obese patients compared with other body mass index groups (both P < 0.01). Conversion to open surgery and superficial surgical site infection were increased in obese patients, and obesity was an independent risk factor for superficial surgical site infection on multivariable analysis (odds ratio 3.0, 95% confidence interval: 1.6-5.6). CONCLUSION: Although obese patients had less severe Crohn's disease at the time of surgery, they experienced increased postoperative infectious complications. Preoperative weight loss and consideration of alternative wound closure methods may reduce these complications.

24 Article Development of an Objective Model to Define Near-Term Risk of Ileocecal Resection in Patients with Terminal Ileal Crohn Disease. 2019

Grass, Fabian / Fletcher, Joel G / Alsughayer, Ahmad / Petersen, Molly / Bruining, David H / Bartlett, David J / Mathis, Kellie L / Lightner, Amy L. ·Department of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, USA. · Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA. · Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA. · Department of Gastroenterology, Mayo Clinic, Rochester, Minnesota, USA. ·Inflamm Bowel Dis · Pubmed #31050733.

ABSTRACT: BACKGROUND: The decision to either escalate medical therapy or proceed to ileocecal resection (ICR) in patients with terminal ileal Crohn disease (CD) remains largely subjective. We sought to develop a risk score for predicting ICR at 1 year from computed tomography or magnetic resonance enterography (CTE/MRE). METHODS: We conducted a retrospective cohort study including all consecutive adult (> 18 years) patients with imaging findings of terminal ileal CD (Montreal classification: B1, inflammatory predominant; B2, stricturing; or B3, penetrating) on CTE/MRE between January 1, 2016, and December 31, 2016. The risk for ICR at 6 months and at 1 year of CTE/MRE and risk factors associated with ICR, including demographics, CD-specific immunosuppressive therapeutics, and disease presentation at the time of imaging, were determined. RESULTS: Of 559 patients, 121 (21.6%) underwent ICR during follow-up (1.4 years [IQR 0.21-1.64 years]); the risk for ICR at 6 months and at 1 year was 18.2% (95% CI 14.7%-21.6%) and 20.5% (95% CI 16.8%-24.1%), respectively. Multivariable analysis revealed Montreal classification (B2, hazard ratio [HR] 2.73, and B3, HR 6.80, both P < 0.0001), upstream bowel dilation (HR 3.06, P < 0.0001), and younger age (19-29 years reference, 30-44 years, HR 0.83 [P = 0.40]; 45-59 years, HR 0.58 [P = 0.04], and 60+ years, HR 0.45 [P = 0.01]) to significantly increase the likelihood of ICR. A predictive nomogram for interval ICR was developed based on these significant variables. CONCLUSIONS: The presence of CD strictures, penetrating complications, and upstream bowel dilation on CTE/MRE, combined with young age, significantly predict ICR. The suggested risk model may facilitate objective therapeutic decision-making.

25 Article Vedolizumab in the Perioperative Management of Inflammatory Bowel Disease. 2019

Lightner, Amy L / Edward V Loftus, ? / McKenna, Nicholas P / Raffals, Laura E. ·Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, Minnesota, United States. · Division of Gastroenterology, Mayo Clinic, Rochester, Minnesota, United States. ·Curr Drug Targets · Pubmed #30914021.

ABSTRACT: BACKGROUND: The isolated effect of vedolizumab on increased postoperative complications remains debated, similar to the controversial data on anti-TNF and postoperative complications. OBJECTIVE: To determine the risk of vedolizumab on postoperative complications. METHODS: A review of the literature available to date on studies comparing postoperative outcomes in vedolizumab-treated versus non-vedolizumab-treated patients was performed. Studies were stratified by those which combined all inflammatory bowel disease together, those specifically focusing on Crohn's disease or ulcerative colitis individually, and those which included pediatric patients alone. RESULTS: The data remains controversial in both the adult and pediatric literature regarding the association of vedolizumab and increased postoperative complications. The strongest association between vedolizumab and an increased risk of postoperative infectious complications seems to be in the Crohn's disease literature. CONCLUSION: Vedolizumab may be associated with an increased risk of postoperative infectious complications in Crohn's disease, but the literature remains controversial due to difficulty in isolating the effect of the biologic alone in a chronically ill, heterogeneous patient population who are on multiple medications including corticosteroids.

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