Preoperative oral polymeric diet enriched with transforming growth factor-beta 2 (Modulen) could decrease...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pediatric Surgery

Background:

• Exclusive polymeric diet enriched with transforming growth factor-beta 2 (ANS-TGF-β2) is established for pediatric Crohn's disease (CD) remission.
• Preoperative use of ANS-TGF-β2 in complicated ileocolonic CD has not been previously evaluated.
• High-risk factors for CD surgery include obstructive symptoms, steroid use, weight loss, and perforation.

Purpose of the Study:

• To evaluate the efficacy of preoperative ANS-TGF-β2 in reducing postoperative complications in pediatric patients undergoing surgery for complicated ileocolonic CD.
• To assess the feasibility of administering ANS-TGF-β2 preoperatively in high-risk CD patients.

Main Methods:

• Prospective data collection from 2011-2015 for consecutive patients undergoing elective ileocolonic CD surgery.
• High-risk patients with complicated CD received exclusive preoperative ANS-TGF-β2.
• Complicated CD defined by obstruction, steroid use, >10% weight loss, or perforation.
• Outcomes compared between high-risk (preoperative ANS-TGF-β2) and low-risk (upfront surgery) groups.

Main Results:

• 35 high-risk patients received preoperative ANS-TGF-β2; 21 low-risk patients had upfront surgery.
• Preoperative ANS-TGF-β2 was feasible in 34/35 high-risk patients.
• Steroid discontinuation achieved in 62.5% of high-risk patients on preoperative ANS-TGF-β2.
• Postoperative complication rates were similar: 23.8% (high-risk) vs. 22.9% (low-risk) (p=1).
• Temporary ileocolostomy rates were 11% (high-risk) vs. 0% (low-risk) (p=0.286).

Conclusions:

• Preoperative ANS-TGF-β2 is feasible for most high-risk pediatric patients with complicated ileocolonic CD.
• This approach may mitigate the negative impact of risk factors on postoperative morbidity.
• Further validation in a large randomized controlled trial is warranted.