Celiac disease surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ajay Gade MD[2]]
Overview
Surgery is not the first line treatment option for patients with celiac disease. Surgery is usually reserved for patients with refractory or pre-malignant complications, such as Enteropathy Associated T-cell Lymphoma (EATL) and ulcerative jejunitis (UJ). EATL patients presenting with ulcerative lesions, stenotic lesions, and perforation needs surgical intervention. Surgery also serves as a pre-therapy in order to prevent perforation of the small bowel during chemotherapy in case of EATL[1]. After surgery patients receive immunotherapy, chemotherapy and/or stem cell transplantation.[2][3]
Surgery
Indications
- Perforation
- Stenosis
- Refractory enteropathy associated T-cell lymphoma (EATL)
- Refractory ulcerative jejunitis (UJ)
Procedure
- The small bowel is resected either by a laparoscopic or a laparotomy procedure depending on the location, the setting (elective/acute) and the preference of the surgeon performing the intervention. [2][3][4]
- Mobilization and transection of the bowel are performed and the involved segment resected if possible.
- Resectability is assessed peri-operatively and has three types:
- Radical: Complete resection of the mass.
- Partial: Some but not all of the mass is resected.
- Unresectable: Inability to resect any part of the mass.
References
- ↑ Di Sabatino A, Biagi F, Gobbi PG, Corazza GR (2012). "How I treat enteropathy-associated T-cell lymphoma". Blood. 119 (11): 2458–68. doi:10.1182/blood-2011-10-385559. PMID 22271451.
- ↑ 2.0 2.1 van de Water JM, Nijeboer P, de Baaij LR, Zegers J, Bouma G, Visser OJ, van der Peet DL, Mulder CJ, Meijerink WJ (2015). "Surgery in (pre)malignant celiac disease". World J. Gastroenterol. 21 (43): 12403–9. doi:10.3748/wjg.v21.i43.12403. PMC 4649123. PMID 26604647.
- ↑ 3.0 3.1 Han SL, Cheng J, Zhou HZ, Guo SC, Jia ZR, Wang PF (2010). "Surgically treated primary malignant tumor of small bowel: a clinical analysis". World J. Gastroenterol. 16 (12): 1527–32. PMC 2846261. PMID 20333796.
- ↑ Coco C, Rizzo G, Manno A, Mattana C, Verbo A (2010). "Surgical treatment of small bowel neoplasms". Eur Rev Med Pharmacol Sci. 14 (4): 327–33. PMID 20496543.