Healing of rectal advancement flaps for anal fistulas in patients with and without Crohn’s disease: a retrospective cohort analysis

Abstract Background Surgical closure of anal fistulas with rectal advancement flaps is an established standard method, but it has a high degree of healing failure in some cases. The aim of this study was to identify risk factors for anal fistula healing failure after advancement flap placement between patients with cryptoglandular fistulas and patients with Crohn’s disease (CD). Methods From January 2010 to October 2020, 155 rectal advancement flaps (CD patients = 55, non-CD patients = 100) were performed. Patients were entered into a prospective database, and healing rates were retrospectively analysed. Results The median follow-up period was 189 days (95% CI: 109–269). The overall complication rate was 5.8%. The total healing rate for all rectal advancement flaps was 56%. CD patients were younger (33 vs. 43 years, p < 0.001), more often female (76% vs. 30%, p < 0.001), were administered more immunosuppressant medication (65% vs. 5%, p < 0.001), and had more rectovaginal fistulas (29% vs. 8%, p = 0.001) and more protective stomas (49% vs. 2%, p < 0.001) than patients without CD. However, no difference in healing rate was noted between patients with or without CD (47% vs. 60%, p = 0.088). Conclusions Patients with anal fistulas with and without Crohn’s disease exhibit the same healing rate. Although patients with CD display different patient-specific characteristics, no independent factors for the occurrence of anal fistula healing failure could be determined. Trial registration Not applicable due to the retrospective study design.

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Healing of rectal advancement flap for anal fistula in patients with and without Crohn’s disease: a retrospective cohort analysis

10.21203/rs.3.rs-244257/v1 ◽

2021 ◽

Author(s):

Claudia Seifarth ◽

Kai S. Lehmann ◽

Cristoph Holmer ◽

Ioannis Pozios

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Anal Fistula ◽

Healing Rate ◽

Advancement Flap ◽

Patient Specific ◽

Anal Fistulas ◽

Surgical Closure ◽

Rectal Advancement Flap ◽

Fistula Healing

Abstract Background Surgical closure of anal fistulas with rectal advancement flap is an established standard method, but in some cases, it has a high degree of healing failure. There are few studies in literature with a small number of cases examining differences between patients with and without Crohn's disease (CD). The aim of this study was to identify risk factors for anal fistula healing failure after advancement flap between patients with cryptoglandular fistulas and patients with CD. Methods From January 2010 to October 2020, 155 rectal advancement flaps (CD patients = 55, non-CD patients = 100) were performed. Patients were entered into a prospective database and retrospectively analyzed for healing rates. Results Median follow up was 189 days (95 % CI: 109–269). Overall complication rate was 5.8 %. Total healing rate for all rectal advanced flaps was 56 %. CD patients were younger (33 vs. 43 years, p < 0.001), more often female (76 vs. 30 %, p < 0.001), had more immunosuppressant medication (65 vs. 5 %, p < 0.001), more vaginal fistulas (29 vs. 8 %, p = 0.001) and more protective stomas (49 vs. 2 %, p < 0.001) than patients without CD. However, there was no difference in the healing rate of patients with or without CD (47 % vs. 60 %, p = 0.088). Conclusions Patients with anal fistulas without and with Crohn’s disease have the same healing rate. Although patients with CD differ in their patient-specific characteristics, no independent factors for the occurrence of anal fistula healing failure could be determined. Trial registration: Not applicable due to the retrospective study design.

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Use of Mesenchymal Stem Cells in Crohn's Disease and Perianal Fistulas: A Narrative Review

Current Stem Cell Research & Therapy ◽

10.2174/1574888x16666210916145717 ◽

2021 ◽

Vol 16 ◽

Author(s):

Azar Sheikholeslami ◽

Hoda Fazaeli ◽

Mohadeseh Khoshandam ◽

Naser Kalhor ◽

Seyyed Jalal Eshaghhosseini ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Cell Therapy ◽

Anal Fistula ◽

Therapeutic Option ◽

Review Article ◽

European Medicines Agency ◽

Anal Fistulas ◽

Necrosis Factor Alpha ◽

Cell Sources

: Crohn's disease (CD) which usually leads to anal fistulas among patients is the most important inflammatory bowel disease that causes morbidity in many people around the world. This review article proposes using MSCs as a hopeful therapeutic strategy for CD and anal fistula treatment in both preclinical and clinical conditions. Finally, Darvadstrocel - a cell based medication to treat complex anal fistulas in adults- as the only European Medicines Agency (EMA)-approved product for the treatment of anal fistulas in CD is addressed. Although several common therapies such as surgery and anti-tumor necrosis factor-alpha (TNF-α) drugs as well as a combination of these methods is used to improve this disease, however, due to the low effectiveness of these treatments, the use of new strategies with higher efficiency is still recommended. Cell therapy is among the new emerging therapeutic strategies that have attracted great attention from clinicians due to its unique capabilities. One of the most widely used cell sources administrated in cell therapy is mesenchymal stem cell (MSC). This review article will discuss preclinical and clinical studies about MSCs as a potent and promising therapeutic option in the treatment of CD and anal fistula.

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P443 Magnetic resonance imaging after ligation of the intersphincteric fistula tract for high perianal fistulas in Crohn’s disease: a retrospective cohort study

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.572 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S399-S400

Author(s):

E Van Praag ◽

K van Rijn ◽

M Monraats ◽

J Stoker ◽

C Buskens

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Fistula Tract ◽

Mri Findings ◽

Perianal Fistulas ◽

Surgical Closure ◽

Fistula Healing ◽

Intersphincteric Fistula ◽

Clinical Healing

Abstract Background Surgical closure of high perianal fistulas using the ligation of the intersphincteric fistula tract (LIFT) procedure is increasingly used in Crohn’s disease. Currently, data on MRI findings after the procedure is lacking, while this is the most important modality to assess deep fistula healing. Therefore, we aimed to evaluate pre- and postoperative fistula characteristics on MRI and the relation with clinical outcomes after LIFT procedure. Methods Consecutive Crohn’s patients treated with LIFT between 2007 and 2018 for high perianal fistulas who underwent a baseline and follow-up (FU) MRI were included in this retrospective study. MRI’s were scored by two radiologists according to a composed score based on the original and modified Van Assche scores with the addition of several items (Table 1). Findings at MRI and the relation to clinical healing were described. Results A total of 12 patients were included (4 male, median age 34 years (IQR 28–39)). The FU MRI was performed a median 5.5 months (IQR 2.5–6.0) after the LIFT procedure. At this time eight patients (67%) reached clinical healing, which increased to ten patients (83%) during follow-up. None had a recurrence. Three patients (25%) needed a re-intervention after the FU MRI due to inflammatory masses and/or persisting fistula tracts. At baseline, all patients showed a tract predominantly filled with granulation tissue, which changed to predominantly fibrotic in seven patients (58%) (Figure 1). All clinically responding patients showed a decrease in tract volume and/or hyperintensity (i.e. activity) with an absence of hyperintensity on T1 and T2 in four (33%) patients. Conclusion Clearly decreased fistula activity can be observed on MRI after LIFT surgery in Crohn’s patients. A large proportion of patients develops a fibrotic tract relatively soon after the procedure and shows no clinical recurrences, suggesting a highly effective therapy and prognostic value of MRI.

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Novel strain-level resolution of Crohn’s disease mucosa-associated microbiota via an ex vivo combination of microbe culture and metagenomic sequencing

The ISME Journal ◽

10.1038/s41396-021-00991-1 ◽

2021 ◽

Author(s):

J. J. Teh ◽

E. M. Berendsen ◽

E. C. Hoedt ◽

S. Kang ◽

J. Zhang ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Ex Vivo ◽

Taxonomic Composition ◽

Strain Level ◽

Patient Specific ◽

Rrna Gene ◽

Metagenomic Sequencing ◽

Functional Characterisation ◽

Bacterial Lineages

AbstractThe mucosa-associated microbiota is widely recognized as a potential trigger for Crohn’s disease pathophysiology but remains largely uncharacterised beyond its taxonomic composition. Unlike stool microbiota, the functional characterisation of these communities using current DNA/RNA sequencing approaches remains constrained by the relatively small microbial density on tissue, and the overwhelming amount of human DNA recovered during sample preparation. Here, we have used a novel ex vivo approach that combines microbe culture from anaerobically preserved tissue with metagenome sequencing (MC-MGS) to reveal patient-specific and strain-level differences among these communities in post-operative Crohn’s disease patients. The 16 S rRNA gene amplicon profiles showed these cultures provide a representative and holistic representation of the mucosa-associated microbiota, and MC-MGS produced both high quality metagenome-assembled genomes of recovered novel bacterial lineages. The MC-MGS approach also produced a strain-level resolution of key Enterobacteriacea and their associated virulence factors and revealed that urease activity underpins a key and diverse metabolic guild in these communities, which was confirmed by culture-based studies with axenic cultures. Collectively, these findings using MC-MGS show that the Crohn’s disease mucosa-associated microbiota possesses taxonomic and functional attributes that are highly individualistic, borne at least in part by novel bacterial lineages not readily isolated or characterised from stool samples using current sequencing approaches.

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Efficacy and Safety of Adalimumab in Canadian Patients with Moderate to Severe Crohn’s Disease: Results of the Adalimumab in Canadian SubjeCts with ModErate to Severe Crohn’s DiseaSe (ACCESS) Trial

Canadian Journal of Gastroenterology ◽

10.1155/2011/724813 ◽

2011 ◽

Vol 25 (8) ◽

pp. 419-425 ◽

Cited By ~ 40

Author(s):

Remo Panaccione ◽

Edward V Loftus ◽

David Binion ◽

Kevin McHugh ◽

Shamsul Alam ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Patient Reported Outcomes ◽

Activity Index ◽

Work Productivity ◽

Clinical Effectiveness ◽

Open Label ◽

Adalimumab Therapy ◽

Patient Reported ◽

Fistula Healing

OBJECTIVE: To evaluate open-label adalimumab therapy for clinical effectiveness, fistula healing, patient-reported outcomes and safety in Canadian patients with moderate to severe Crohn’s disease (CD) who were either naive to or previously exposed to antitumour necrosis factor (anti-TNF) therapy.METHODS: Patients with moderate to severe CD (CD activity index [CDAI] score of greater than 220, or Harvey-Bradshaw index [HBI] of 7 or greater) were eligible. Patients received open-label adalimumab as induction (160 mg and 80 mg subcutaneously [sc]) at weeks 0 and 2, respectively and maintenance (40 mg sc every other week) therapy. At or after eight weeks, patients with flare or nonresponse could have their dosage increased to 40 mg sc weekly. Patients were followed for a minimum of six months or until adalimumab was commercially available in Canada.RESULTS: Of the 304 patients enrolled, 160 were infliximab experienced, while 144 were anti-TNF naive. HBI remission (HBI score of 4 or lower) at week 24 was achieved by 53% of anti-TNF-naive and 36% of infliximab-experienced patients (P<0.01; P<0.001 for both groups for all visits versus baseline). Fistula healing rates at week 12 were 48% for anti-TNF-naive patients, and 26% for infliximab-experienced patients. At week 24, fistula healing rates were significantly greater for the anti-TNF-naive group (60% versus 28%; P<0.01). Improvements in quality of life and work productivity were sustained from week 4 to week 24 for all patients. Serious infections occurred in 2% of patients.CONCLUSIONS: Adalimumab therapy induced and sustained steroid-free remission in both infliximab-experienced and anti-TNF-naive patients with moderate to severe CD. Clinically meaningful rates of fistula healing were also observed. Improvements in patient-reported outcomes were sustained throughout the 24-week study period.

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