Health Care Costs of Complex Perianal Fistula in Crohn’s Disease

Chaparro, María; Zanotti, Carlo; Burgueño, P.; Vera, Isabel; Bermejo, Fernando; Marín-Jiménez, Ignacio; Yela, Carmen; López, Pilar Sáez; Martín, Mercedes; Taxonera, Carlos; Botella, Belén; Pajares, Ramón; Ponferrada, Ángel; Calvo, M.; Algaba, Alicia; Pérez, Luis C. Velázquez; Casís, Begoña; Maté, José; Orofino, Javier; Lara, Núria; Garcı́a-Losa, Manuel; Badı́a, Xavier; Gisbert, Javier P.

doi:10.1007/s10620-013-2830-7

Cited by 40 publications

(30 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Nevertheless, the real efficacy is currently difficutl to assess [5] . A recent Spanish study revealed that the mean annual global cost of conventional treatments for patients with Crohn's disease and perianal fistulae is > € 8000/year [10] . According to current regulatory issues at the time (2002), our team started a clinical trial process in order to test the ability of adipose-derived stem cells (ASC) to improve healing in complex perianal fistulae, including those associated with Crohn's disease.…”

Section: Introductionmentioning

confidence: 99%

Recurrent anal fistulae: Limited surgery supported by stem cells

García-Olmo¹,

Guadalajara²,

Rubio-Perez³

et al. 2015

WJG

View full text Add to dashboard Cite

I collaborated in the analysis and interpretation of data, critically revised the main text and content, and wrote the final version of the paper; Herreros MD collaborated in design and conception of the study and performed the surgical interventions; de-la-Quintana P contributed to the first acquisition of data from patients in the outpatient clinics and their analysis; Garcia-Arranz M provided cell resources and managed all regulatory and legal aspects related to the study, participating in design and conception, and contributed to the revision of contents related to cell behavior and physiology; all authors revised and approved the final version to be published. METHODS:Under controlled circumstances, and approved by European and Spanish laws, a Compassionate-use Program allows the use of stem-cell therapy for patients with very complex anal fistulae. Candidates had previously undergone multiple surgical interventions that had failed to resolve the fistulae, and presented symptomatic recurrence. The intervention consisted of limited surgery (with closure of the internal opening), followed by local implant of stem cells in the fistula- Observational StudyORIGINAL ARTICLE tract wall. Autologous expanded adipose-derived stem cells were the main cell type selected for implant. The first evaluation was performed on the 8 th postoperative week; outcome was classified as response or partial response. Evaluation one year after the intervention confirmed if complete healing of the fistula was achieved. RESULTS:Ten patients (8 male) with highly recurrent and complex fistulae were treated (mean age: 49 years, range: 28-76 years). Seven cases were nonCrohn's fistulae, and three were Crohn's-associated fistulae. Previous surgical attempts ranged from 3 to 12. Two patients presented with preoperative incontinence (Wexner scores of 12 and 13 points). After the intervention, six patients showed clinical response on the 8 th postoperative week, with a complete cessation of suppuration from the fistula. Three patients presented a partial response, with an evident decrease in suppuration. A year later, six patients (60%) remained healed, with complete reepithelization of the external opening. Postoperative Wexner Scores were 0 in six cases. The two patients with previous incontinence improved their scores from 12 to 8 points and from 13 to 5 points. No adverse reactions or complications related to stem-cell therapy were reported during the study period. CONCLUSION:Stem cells are safe and useful for treating anal fistulae. Healing can be achieved in severe cases, sparing fecal incontinence risk, and improving previous scoring. Core tip: Our group has performed various clinical trials with adipose stem cells. Patients with very complex fistulae, multiple previous surgeries, and treatment failure are generally not able to enter these studies despite the benefit and "last chance" of cure. We present the results of a Compassionate-use Program, which enabled the application of stem-cell therapy to these patients, under strict regul...

show abstract

Section: Introductionmentioning

confidence: 99%

Recurrent anal fistulae: Limited surgery supported by stem cells

García-Olmo¹,

Guadalajara²,

Rubio-Perez³

et al. 2015

WJG

View full text Add to dashboard Cite

show abstract

“…The prevalence of PCD in different studies varies between 21% and 54% of CD patients; it is more frequent in cases of isolated colonic involvement (up to 41%), versus only 12% in patients with isolated ileal disease. It has been identified as an indicator of poor prognosis and is associated with increased healthcare costs [2,3]. …”

Section: Definition Epidemiology and Burden Of Cpcdmentioning

confidence: 99%

“…A recent Spanish retrospective multicenter study of 97 cases of CPCD, conducted in the Madrid area [2], analyzed baseline patient characteristics and treatments indicated in real-life clinical practice. Antibiotics were administered in 32.3% of cases, immunomodulators in 20.5%, biological agents in 20.3%, and 27% were treated surgically.…”

Section: Definition Epidemiology and Burden Of Cpcdmentioning

confidence: 99%

Management of complex perianal Crohn’s disease

Aguilera

Ferre‐Aracil

Paredes

et al. 2016

aog

View full text Add to dashboard Cite

Patients with Crohn’s disease often develop perianal disease, successfully managed in most cases. However, its most aggressive form, complex perianal disease, is associated with high morbidity and a significant impairment in patients’ quality of life. The aim of this review is to provide an updated approach to this condition, reviewing aspects of its epidemiology, diagnosis and therapeutic alternatives. Emerging treatment options are also discussed. A multidisciplinary assessment of these patients with a coordinated medical and surgical approach is crucial.

show abstract

“…[5][6][7] All patients were informed about the procedures including using BRCC, and the written consent meeting the standards set by the hospitals' institutional review board was obtained before MRI examination. [5][6][7] All patients were informed about the procedures including using BRCC, and the written consent meeting the standards set by the hospitals' institutional review board was obtained before MRI examination.…”

Section: Patient Selection and Data Collectionmentioning

confidence: 99%

“…2 The classification of anal fistula was proposed by Parks et al, who assigned the fistulas into 1 of 4 groups: intersphincteric, transsphincteric, suprasphincteric, and extrasphincteric. 2,[5][6][7] For the patients with chronic inflammatory disease of the gastrointestinal tract such as Crohn disease or with the repeated surgical treatments, 2 or more fistulas or internal openings, sometimes the iatrogenic internal openings caused by operations, may be detected, and the location of these lesions may be very deep. 2,[5][6][7] For the patients with chronic inflammatory disease of the gastrointestinal tract such as Crohn disease or with the repeated surgical treatments, 2 or more fistulas or internal openings, sometimes the iatrogenic internal openings caused by operations, may be detected, and the location of these lesions may be very deep.…”

mentioning

confidence: 99%