Thread by @Jonathansegal85

Roadmap to optimal peri-operative care in #IBD a 🧵on the lastest #ECCO topical review in #JCC. Led by @AntoninoSpin and @ibdseb
Open 📞 13 selected from 36 applicants with targets ⚖️ for gender, geographical and speciality expertise. ✂️💊💉

15 authors with 4 group leaders supporting junior researchers. Each working group performed a key systematic search using key questions related to peri-operative care in #IBD What did we find?👀

Peri-operative use of drugs💊💉

Pts needing surgical intervention for #IBD, biological treatment can be continued during the peri-operative period.

pts needing surgical intervention for #IBD immunomodulators can be continued during the peri-operative period.

Steroid withdrawal is strongly recommended prior to surgical interventions in patients with #IBD whenever possible. Where complete withdrawal is not achievable, progressive tapering to the lowest dose is recommended.

Longer use of pre-operative prophylactic antibiotics and antibiotic use as part of bowel preparation in IBD might be beneficial. More 🧐👩‍🔬 is needed to explore the duration of prophylaxis, route of administration and type of antibiotics.

Peri-operative nutrition:🍔🌭🌮🌯🥙🥗🍕🥪

Prevalence of malnutrition is ⬆️in pts with active disease and in CD compared with UC. Malnutrition in surgical patients with IBD worsens clinical outcomes- recommend nutritional status is optimized before elective surgery when possible.

In the pre-operative period, all patients should be routinely screened for malnutrition (including BMI and unintentional weight loss as a minimum). In those identified to be at risk, full nutritional assessment should be performed.

Pre-operative exclusive enteral nutrition in patients with stricturing or penetrating CD improves nutritional status and may reduce postoperative complications. The multidisciplinary team should determine the most appropriate treatment duration and route of administration.

In malnourished patients with CD administration of PN pre- op may ⬇️ overall postoperative complications, PN can be used to optimize nutritional status before surgery as a supplement to EN, or as an alternative if en is not possible or is CI

The role of enteral or parenteral nutrition in improving the surgical outcomes of patients with UC requires further studies.

The use of immunonutrition in improving postoperative outcomes in adult IBD patients requires further studies.

Psychological rehabilitation:🔮

The need for peri-operative psychological care for patients with IBD who undergo surgery should be considered. Specific psychological assessment tools and interventions for patients with IBD undergoing surgery remain largely unexplored.

Patients with IBD experience variable degrees of limitation in activity after surgery.🏃🏻‍♀️🏃🏻🏃‍♂️🏋🏻‍♂️🏋️

Sarcopenia in patients with IBD is associated with a more aggressive disease course and higher short- and long-term postoperative complication rates. 💪🏼💪🏼💪🏼

Peri-operative physical rehabilitation may be beneficial to optimise postoperative recovery in IBD. Rehabilitation programmes should be multidimensional and the modality and intensity need to be adapted to patients’ baseline characteristics.

Physical rehabilitation should be delivered in a setting that facilitates patient participation 🤸🏾‍♀️🏋️👟

Fe deficiency

Screening for anaemia is recommended prior to IBD surgery. Intravenous iron is likely to correct iron deficiency anaemia more quickly than oral supplementation.

Pre-operative stoma counselling and marking should be carried out by appropriately trained specialists including stoma therapists or specialist nurses. Patients can benefit from pre operative counselling

The use of enhanced recovery principles in colorectal surgery is recommended to improve immediate postoperative recovery. These protocols should be tailored to the specific needs of patients with IBD

Re-introduction or initiation of biological and/or immunomodulatory therapy after abdominal surgery in CD depends on multiple factors such as the type of agent, the presence of residual disease, risk stratification for recurrence and postoperative complications

Patients with IBD have an increased risk of thromboembolic events. Thromboprophylaxis is recommended for all surgical patients and should be extended after discharge in patients with relevant risk factors.

Many contributors to this including @GianlucaPellino @AlaaEl_Hussuna @jdcamcolorectal @ibdseb @AntoninoSpin @Y_ECCO_IBD @pakotze @HedinCharlotte @MichelAdamina and many more…
Check it out here: academic.oup.com/ecco-jcc/advan…