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Indications include: Medically refractory disease not responding to optimized biologic therapy Bowel obstruction from fibrostenotic stricture Intra-abdominal abscess not amenable to percutaneous drainage Complex perianal fistula (seton placement, diversion) Enterocutaneous or enterovesical fistula Dysplasia or cancer in Crohns colitis Free perforation (rare) Nutritional Therapy Exclusive enteral nutrition (EEN) effective for induction in pediatric Crohns

For instance, excessive metabolic burden can reduce therapeutic efficacy, and the loss of surface functions increases their susceptibility to immune recognition and clearance [91]

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