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Postoperative complications of pediatric patients with inflammatory bowel disease treated with vedolizumab
Lori A Zimmerman1, Jill M Zalieckas2, Robert C Shamberger2
1IBD Center, Boston Children's Hospital, Boston, MA.
Insights
Patients treated with vedolizumab (an anti-adhesion biologic) before surgery experienced more postoperative complications, particularly stoma issues. Further research is needed to confirm if vedolizumab causes these adverse surgical outcomes in pediatric ulcerative colitis and Crohn's disease patients.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Inflammatory Bowel Disease
Background:
- Vedolizumab is a biologic therapy targeting leukocyte adhesion, used for ulcerative colitis (UC) and Crohn's disease (CD).
- Limited data exists on the surgical outcomes of patients treated with vedolizumab.
- This study investigated postoperative complications in pediatric UC and CD patients who received vedolizumab.
Purpose of the Study:
- To evaluate the surgical outcomes and postoperative complications in pediatric patients with ulcerative colitis and Crohn's disease treated with vedolizumab.
- To compare complication rates between vedolizumab-exposed and vedolizumab-naive patients undergoing surgery requiring diverting ileostomy.
Main Methods:
- Retrospective review of pediatric UC and CD patients treated with vedolizumab between 2014 and 2016.
- Comparison of postoperative outcomes between a vedolizumab-exposed group and a vedolizumab-naive group requiring diverting ileostomy.
- Level III evidence.
Main Results:
- Of 31 patients treated with vedolizumab, 13 required surgery. 62% (8/13) of vedolizumab-exposed patients experienced postoperative complications.
- Complications included mucocutaneous separation, pain/dehydration readmission, bowel obstruction, and intraoperative colonic perforation.
- In comparison, 25% (4/16) of vedolizumab-naive patients had complications (p=0.07).
Conclusions:
- Patients treated with vedolizumab prior to surgery exhibited a high incidence of postoperative complications, especially mucocutaneous stoma separation.
- Further prospective, multicenter studies are necessary to ascertain if vedolizumab is causally linked to these observed complications.
Background:
Vedolizumab is a biologic, which inhibits leukocyte adhesion in the gut and is used to treat ulcerative colitis (UC) and Crohn's disease (CD). Little is known of the surgical outcomes in patients treated with vedolizumab. We reviewed the postoperative complications in a cohort of pediatric UC and CD patients treated with vedolizumab.
Methods:
We identified pediatric UC and CD patients treated with vedolizumab at our institution from 2014 to 2016. We compared postoperative outcomes in the vedolizumab exposed group to a cohort of vedolizumab naïve patients who required diverting ileostomy.
Results:
Of the 31 patients who were treated with vedolizumab, 13 patients required surgery. Eight of 13 (62%) vedolizumab exposed patients had a postoperative complication, including mucocutaneous separation at the stoma (3), readmission for pain/dehydration (2), bowel obstruction at the ostomy, and intraoperative colonic perforation. In comparison, four of 16 (25%) vedolizumab naive patients had a postoperative complication, including readmission for ileus and for high stoma output with mucocutaneous separation. p=0.07.
Conclusions:
At our institution, patients treated with vedolizumab prior to surgery have a high prevalence of postoperative complications, notably mucocutaneous separation of the stoma. A prospective, multicenter study is needed to determine if these observed complications are attributable to vedolizumab.
Level Of Evidence:
Level III.
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