title: Preoperative oral polymeric diet enriched with transforming growth factor-beta 2 (Modulen) could decrease postoperative morbidity after surgery for complicated ileocolonic Crohn's disease.
abstract: OBJECTIVE
  Exclusive polymeric diet enriched with transforming growth factor-beta 2 (ANS-TGF-β2) has been used for remission induction and maintenance in pediatric Crohn's disease (CD). Its use in the preoperative setting has never been evaluated. The aim of this study was to evaluate preoperative ANS-TGF-β2 to decrease postoperative complications after surgery for complicated ileocolonic CD.
  
  
  METHODS
  From 2011 to 2015, data of all consecutive patients who underwent elective surgery for ileocolonic CD were collected prospectively. Preoperative, exclusive ANS-TGF-β2 was administered in high-risk patients with complicated CD. Complicated CD was defined by the presence of obstructive symptoms, and/or steroid treatment, and/or preoperative weight loss >10% and/or perforating CD. Outcomes of high-risk patients receiving preoperative ANS-TGF-β2 were compared to those of low-risk patients with no complicated CD who underwent upfront surgery.
  
  
  RESULTS
  Fifty-six patients underwent surgery for ileocolonic CD. Among them, 35 high-risk patients received preoperative ANS-TGF-β2 and 21 low-risk patients underwent upfront surgery. Preoperative full-dose ANS-TGF-β2 was feasible in 34/35 high-risk patients. Discontinuation of steroids during preoperative ANS-TGF-β2 could be achieved in 10/16 patients (62.5%). Postoperative complications rates were 8/35 (23.8%) and 5/21 (22.9%) in high-risk and low-risk patients, respectively (p = 1). Temporary ileocolostomy rates in high-risk patients and in low-risk patients were 4/35 (11%) and 0/21, respectively (p = 0.286) Conclusion: Preoperative ANS-TGF-β2 is feasible in most high-risk patients with complicated ileocolonic CD and could limit the deleterious effects of risk factors of postoperative morbidity. These results need to be confirmed in a large randomized controlled trial.
authors.affiliation: a Department of Digestive and Oncologic Surgery, Assistance Publique Hôpitaux de Paris , Université Paris-Sud , Le Kremlin Bicêtre , France.
authors.forename: Nathan
authors.initials: N
authors.lastname: Beaupel
authors.affiliation: a Department of Digestive and Oncologic Surgery, Assistance Publique Hôpitaux de Paris , Université Paris-Sud , Le Kremlin Bicêtre , France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Brouquet
authors.affiliation: a Department of Digestive and Oncologic Surgery, Assistance Publique Hôpitaux de Paris , Université Paris-Sud , Le Kremlin Bicêtre , France.
authors.forename: Solafah
authors.initials: S
authors.lastname: Abdalla
authors.affiliation: b Department of Gastroenterology, Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris , Université Paris-Sud , Le Kremlin Bicêtre , France.
authors.forename: Franck
authors.initials: F
authors.lastname: Carbonnel
authors.affiliation: a Department of Digestive and Oncologic Surgery, Assistance Publique Hôpitaux de Paris , Université Paris-Sud , Le Kremlin Bicêtre , France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Penna
authors.affiliation: a Department of Digestive and Oncologic Surgery, Assistance Publique Hôpitaux de Paris , Université Paris-Sud , Le Kremlin Bicêtre , France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Benoist
mesh_terms: D000328:Adult; D000368:Aged; D003424:Crohn Disease / Q000601:surgery / Q000628:therapy*; D004032:Diet; D019587:Dietary Supplements; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D005602:France; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D012074:Remission Induction; D012307:Risk Factors; D053781:Transforming Growth Factor beta2 / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D053781:Transforming Growth Factor beta2
keywords: Crohn’s disease; enteral nutrition; inflammatory bowel diseases; polymeric diet enriched with transforming growth factor-beta 2