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Surgery in (pre)malignant celiac disease.

Jolanda M W van de Water1, Petula Nijeboer1, Laura R de Baaij1

  • 1Jolanda MW van de Water, Petula Nijeboer, Laura R de Baaij, Jessy Zegers, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology and Hepatology, Coeliac Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, The Netherlands.

World Journal of Gastroenterology
|November 26, 2015
PubMed
Summary

Early surgical resection for malignant celiac disease (CD) improves survival, despite high complication rates. Prompt intervention is key for better outcomes in patients with these rare gastrointestinal conditions.

Keywords:
Celiac diseaseEnteropathy associated T-cell lymphomaRefractory celiac diseaseUlcerative jejunitis

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Area of Science:

  • Gastroenterology
  • Surgical Oncology
  • Oncology

Background:

  • Celiac disease (CD) can progress to (pre)malignant conditions, including ulcerative jejunitis and enteropathy-associated T-cell lymphoma (EATL).
  • Management of these aggressive conditions often involves complex surgical interventions.

Purpose of the Study:

  • To evaluate the surgical outcomes and survival impact in patients diagnosed with (pre)malignant conditions associated with celiac disease.
  • To compare survival rates between surgical resection and chemotherapy-only treatment for EATL.

Main Methods:

  • Retrospective analysis of 40 patients with (pre)malignant CD conditions (ulcerative jejunitis and EATL) who underwent surgery between 2002-2013.
  • Inclusion of 11 EATL patients treated with chemotherapy alone as a control group for survival analysis.
  • Data collection on surgical indications, procedures, complications, adjuvant therapy, and overall survival (OS).

Main Results:

  • The majority of surgeries were elective, with functional stenosis and perforation as primary indications.
  • Radical resection was achieved in 70% of patients, with a 35% early postoperative complication rate.
  • Patients undergoing acute surgery had higher mortality, and surgical resection significantly improved OS compared to chemotherapy alone.

Conclusions:

  • Despite a high complication rate, early local resection is the preferred initial treatment for (pre)malignant CD.
  • Prompt surgical intervention is crucial for improving survival outcomes in these patients.