Modern management of perianal fistulas in Crohn’s disease: future directions

Gut ◽  
2018 ◽  
Vol 67 (6) ◽  
pp. 1181-1194 ◽  
Author(s):  
Paulo Gustavo Kotze ◽  
Bo Shen ◽  
Amy Lightner ◽  
Takayuki Yamamoto ◽  
Antonino Spinelli ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Negative Impact ◽  
Care Delivery ◽  
Surgical Techniques ◽  
Models Of Care ◽  
Surgical Approaches ◽  
Perianal Fistulas ◽  
Modern Management ◽  
Perianal Fistulae

Perianal fistulae in patients with Crohn’s disease (CD) can be associated with significant morbidity resulting in negative impact on quality of life. The last two decades have seen significant advancements in the management of perianal fistulas in CD, which has evolved into a multidisciplinary approach that includes gastroenterologists, colorectal surgeons, endoscopists and radiologists. Despite the introduction of new medical therapies such as antitumour necrosis factor and novel models of care delivery, the best fistula healing rates reported with combined medical and surgical approaches are approximately 50%. More recently, newer biologics, cell-based therapies as well as novel endoscopic and surgical techniques have been introduced raising new hopes that outcomes can be improved upon. In this review, we describe the modern management and the most recent advances in the management of complex perianal fistulising CD, which will likely impact clinical practice. We will explore optimal use of both older and newer biological agents, as well as new data on cell-based therapies. In addition, new techniques in endoscopic and surgical approaches will be discussed.

scholarly journals Minor Sphincter Sparing Surgery for Successful Closure of Perianal Fistulas in Patients with Crohn’s Disease

2021 ◽  
Vol 10 (20) ◽  
pp. 4721
Author(s):  
Jennifer Merten ◽  
Ann-Kathrin Eichelmann ◽  
Rudolf Mennigen ◽  
Isabelle Flammang ◽  
Andreas Pascher ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
Advancement Flap ◽  
University Hospital ◽  
High Rate ◽  
Surgical Interventions ◽  
Perianal Fistulas ◽  
Fistula Plug

The purpose of this study is to demonstrate that repetitive minor surgical procedures allow for a high rate of permanent closure of perianal fistulas in patients with Crohn’s disease (CD). Patients with perianal fistulizing CD (PFCD) who underwent perianal surgery at the University Hospital of Muenster between 2003 and 2018 were assessed for fistula characteristics and surgical procedures. We included 45 patients (m:f = 28:17) with a mean age of 27 years at first fistula appearance. Of these, 49% suffered from a complex fistula. An average of 4.2 (1–14) procedures were performed, abscess incisions and fistula-seton-drainages included. Draining setons were left in place for 5 (1–54) months, until fistula closure. Final surgical techniques were fistulotomy (31.1%), seton removal with sustained biological therapy (26.7%), Anal Fistula Plug (AFP) (17.8%), Over-The Scope-Clip proctology (OTSC) (11.1%), and mucosa advancement flap (4.4%). In 8.9% of cases, the seton was kept as permanent therapy. The time from first to last surgery was 18 (0–182) months and the median follow-up time after the last surgery was 90 (15–200) months. The recurrence rate was 15.5% after 45 (17–111) months. Recurrent fistulas healed after another 1.86 (1–2) surgical re-interventions. The final success rate was 80%. Despite biological treatment, PFCD management remains challenging. However, by repeating minor surgical interventions over a prolonged period of time, high permanent healing rates can be achieved.

Cell-based Therapy for Perianal Fistulising Crohn’s Disease

2019 ◽  
Vol 25 (1) ◽  
pp. 41-46 ◽  
Author(s):  
Paulo Gustavo Kotze ◽  
Antonino Spinelli ◽  
Amy Lee Lightner
Keyword(s):  
Stem Cells ◽  
Mesenchymal Stem Cells ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Therapeutic Option ◽  
Surgical Techniques ◽  
Phase Iii ◽  
Perianal Fistulas ◽  
Cell Based Therapy ◽  
Future Challenges

Background: The management of complex perianal fistulas in Crohn’s disease (CD) represents a challenge for patients, gastroenterologists and colorectal surgeons. There are clear limitations with current medical and surgical options, and healing rates remain far from what is expected. A multidisciplinary approach with optimized medical therapy, usually anti-TNF agents, associated with setons and additional surgical techniques is currently the best strategy to aim fistula healing. Methods: A comprehensive review of the literature was conducted on the use of mesenchymal stem cells (MSCs). Results: The use of mesenchymal stem cells (MSCs) has recently emerged as a promising new therapeutic strategy for complex fistulas in CD patients. This review summarizes the evidence of the use of MSCs in complex CD fistulas, by exploring in detail the types of cells that can be used and their modes of delivery. Additionally, the results of the most recent phase III randomized trial with local MSCs injection are described, and future challenges of this therapeutic option are discussed. Conclusion: The use of MSCs represents hope for better outcomes in patients with CD-related perianal fistulas. More research in the field will help to position this specific therapy in treatment algorithms.

Fr484 A NANOFIBER-HYDROGEL COMPOSITE PLUG FOR PERIANAL FISTULAS IN CROHN'S DISEASE

2021 ◽  
Vol 160 (6) ◽  
pp. S-326
Author(s):  
Ling Li ◽  
Zhicheng Yao ◽  
Susan Gearhart ◽  
Calvin Chang ◽  
Jiayuan Kong ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Perianal Fistulas ◽  
Hydrogel Composite

scholarly journals Pathogenesis and management of gastrointestinal inflammation and fibrosis: from inflammatory bowel diseases to endoscopic surgery

2021 ◽  
Vol 41 (1) ◽  
Author(s):  
Kentaro Iwata ◽  
Yohei Mikami ◽  
Motohiko Kato ◽  
Naohisa Yahagi ◽  
Takanori Kanai
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Tissue Repair ◽  
Relevant Literature ◽  
Surgical Techniques ◽  
Treatment Strategies ◽  
Extended Resection ◽  
Bowel Diseases ◽  
Technical Advances ◽  
Inflammatory Bowel

AbstractGastrointestinal fibrosis is a state of accumulated biological entropy caused by a dysregulated tissue repair response. Acute or chronic inflammation in the gastrointestinal tract, including inflammatory bowel disease, particularly Crohn’s disease, induces fibrosis and strictures, which often require surgical or endoscopic intervention. Recent technical advances in endoscopic surgical techniques raise the possibility of gastrointestinal stricture after an extended resection. Compared to recent progress in controlling inflammation, our understanding of the pathogenesis of gastrointestinal fibrosis is limited, which requires the development of prevention and treatment strategies. Here, we focus on gastrointestinal fibrosis in Crohn’s disease and post-endoscopic submucosal dissection (ESD) stricture, and we review the relevant literature.

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