Surgical management of duodenal crohn’s disease

Background: Operative options for duodenal Crohn’s disease include bypass, stricturoplasty, or resection. What factors are associated with operation selection and whether differences exist in outcomes is unknown. Methods: Patients with duodenal Crohn’s disease requiring operative intervention across a multi-state health system were identified. Patient and operative characteristics, short-term surgical outcomes, and the need for future endoscopic or surgical management of duodenal Crohn’s disease were analyzed. Results: 40 patients underwent bypass (n = 26), stricturoplasty (n = 8), or resection (n = 6). Median age of diagnosis of Crohn’s disease was 23.5 years, and over half of the patients had undergone prior surgery for CD. Operation type varied by the most proximal extent of duodenal involvement. Patients with proximal duodenal CD underwent bypass operations more commonly than those with mid- or distal duodenal disease (p = 0.03). Patients who underwent duodenal stricturoplasty more often required concomitant operations for other sites of small bowel or colonic CD (63%) compared to those who underwent bypass (39%) or resection (33%). No patients required subsequent surgery for duodenal CD at a median follow-up of 2.8 years, but two patients required endoscopic dilation (n = 1 after stricturoplasty, n = 1 after resection). Conclusion: Patients who require surgery for duodenal Crohn’s disease appear to have an aggressive Crohn’s disease phenotype, represented by a younger age of diagnosis and a high rate of prior resection for Crohn’s disease. Choice of operation varied by proximal extent of duodenal Crohn’s disease.