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Early Versus Late Surgery in Patients With Intestinal Behçet Disease

Jung, Yoon Suk M.D., M.S.1; Hong, Sung Pil M.D., Ph.D.1; Kim, Tae Il M.D., Ph.D.1; Kim, Won Ho M.D., Ph.D.1,2; Cheon, Jae Hee M.D., Ph.D.1,2

Diseases of the Colon & Rectum: January 2012 - Volume 55 - Issue 1 - p 65–71
doi: 10.1097/DCR.0b013e318238b57e
Original Contributions

BACKGROUND: To date, no studies have been conducted to evaluate the potential benefits of early surgery in patients with intestinal Behçet disease.

OBJECTIVE: We investigated the long-term clinical outcomes in patients with intestinal Behçet disease first diagnosed at surgery (“early surgery”) compared with those requiring surgical resection during the course of the disease (“late surgery”).

DESIGN: This is a retrospective cohort study.

SETTINGS: This study was conducted at a single tertiary academic medical center.

PATIENTS: We reviewed the medical records of 272 consecutive patients with intestinal Behçet disease between March 1986 and August 2010.

MAIN OUTCOME MEASURES: The cumulative probabilities of clinical recurrence and reoperation after operation were the main outcomes measures.

RESULTS: Forty of 272 patients were first diagnosed with intestinal Behçet disease at surgery (early surgery); the remaining 232 were diagnosed clinically, with 62 undergoing surgery during their follow-up after clinical diagnosis (late surgery). The cumulative probabilities of postoperative clinical recurrence and reoperation were significantly lower in the early-surgery group than in the late-surgery group (p = 0.045 and p = 0.003). In multivariate analysis, early surgery was the only independent factor significantly associated with a reduced probability of reoperation (HR 0.26; 95% CI 0.10–0.71; p = 0.008). However, when we analyzed only the patients who underwent surgery because of chronic symptoms, early surgery was not associated with lower cumulative clinical recurrence and reoperation rates (p = 0.896 and p = 0.492).

LIMITATIONS: We analyzed the clinical characteristics retrospectively, and the number of patients was insufficient to reach a decisive conclusion.

CONCLUSIONS: According to the current study, the patients with intestinal Behçet disease undergoing early surgery showed better prognoses in comparison with those undergoing late surgery. Early surgery may represent a valid approach in the initial management of the patients with intestinal Behçet disease, at least in the subset of the patients with acute symptoms.

1 Department of Internal Medicine and Institute of Gastroenterology, Yonsei University College of Medicine, Seoul, Republic of Korea

2 Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea

Disclosures: None reported.

Correspondence: Jae Hee Cheon, M.D., Ph.D., Division of Gastroenterology, Department of Internal Medicine, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu, Seoul, Republic of Korea. E-mail:

© The ASCRS 2012