Deep remission on magnetic resonance imaging impacts outcomes of perianal fistulizing Crohn’s disease

Chambaz, Marion; Verdalle-Cazes, Mikael; Desprez, Charlotte; Thomassin, Lucie; Charpentier, C; Grigioni, S.; Armengol-Debeir, Laura; Bridoux, Valérie; Savoye, Guillaume; Savoye‐Collet, Céline

doi:10.1016/j.dld.2018.12.010

Cited by 29 publications

(18 citation statements)

References 35 publications

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“…One additional patient achieved this endpoint at week 60, resulting in a total of 4 out of 20 (20%) patients with a fibrotic complex. This is an important finding, because deep remission on MRI is associated with a low chance of recurrence of perianal disease 26 . This long‐term effect helps justify the duration and the cost of the treatment.…”

Section: Discussionmentioning

confidence: 89%

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Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease: Results of the HOT‐TOPIC trial after 1‐year follow‐up

et al. 2022

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Background: Previously published short-term results (week 16) of this trial showed a significant improvement in clinical, radiologic and biochemical outcomes in Crohn's disease patients with therapy-refractory perianal fistulas after treatment with hyperbaric oxygen therapy.Objective: To assess the long-term (week 60) efficacy, safety and feasibility of hyperbaric oxygen therapy in perianal fistula in Crohn's disease.Methods: Crohn's disease patients with high perianal fistula(s) failing conventional treatment >6 months were included. Exclusion criteria were presence of a stoma, rectovaginal fistula(s) and recent changes in treatment regimens. Patients received 40 hyperbaric oxygen sessions and outcomes were assessed at week 16 and week 60.Results: Twenty patients were included (median age 34 years). At week 16, median scores of the perianal disease activity index and modified Van Assche index (coprimary outcomes) decreased from 7.5 (95% CI 6-9) to 4 (95% CI 3-6, p < 0.001) and 9.2 (95% CI 7.3-11.2) to 7.3 (95% CI 6.9-9.7, p = 0.004), respectively. At week 60, the respective scores remained significantly lower than baseline: 4 (95% CI 3-7, p < 0.001) and 7.7 (95% CI 5.2-10.2, p = 0.003). Perianal disease activity index score of 4 or less (representing inactive perianal disease) was observed in 13 patients at week 16 and 12 patients at week 60. Using fistula drainage assessment, 12 and 13 patients showed a clinical response at week 16 and 60, respectively, and clinical remission was achieved in four patients for both time points. At week 16, a statistically significant biochemical improvement (C-reactive protein and faecal calprotectin levels) was found, but this effect was no longer significant at week 60. Conclusions:The clinical and radiologic improvement of perianal fistula in Crohn's disease, that was found at week 16 after treatment with hyperbaric oxygen therapy, is maintained at 1-year follow-up.

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Section: Discussionmentioning

confidence: 89%

“…This is an important finding, because deep remission on MRI is associated with a low chance of recurrence of perianal disease. 26 This long‐term effect helps justify the duration and the cost of the treatment. Furthermore, a completely fibrotic fistula complex is a relatively rare outcome of treatment, especially for medical therapy.…”

Section: Discussionmentioning

confidence: 99%

Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease: Results of the HOT‐TOPIC trial after 1‐year follow‐up

et al. 2022

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“…Interestingly, we observed a predominantly, but not completely, fibrotic tract in another 30% of patients. Chambaz et al [19] found that deep remission (clinical remission and absence of enhancement on MRI) is associated with higher flare-free survival, but the value of a predominantly, but not completely, fibrotic tract on MRI is unknown. Only one retrospective study reports this feature after anti-TNF treatment, with predominant fibrosis being seen in only 3 out of 30 patients within 18 months [20].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

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Aim Ligation of the intersphincteric fistula tract (LIFT) is increasingly being used for surgical closure of high perianal fistulas in Crohn’s disease. Currently, data on postoperative MRI findings are scarce, although they are considered important for assessing healing and recurrence. Our aim, therefore, was to evaluate fistula characteristics on MRI and their relationship with clinical outcomes after LIFT. Method Consecutive Crohn's patients treated with LIFT between 2007 and 2018 who underwent baseline and follow‐up MRI were retrospectively included. MRIs were scored by two radiologists according to characteristics based on the original and modified Van Assche indices. MRI findings, with emphasis on fibrosis, and the relationship with clinical healing, re‐interventions and recurrences are described. Results Twelve patients were included [four men, median age 34 (interquartile range 28–39) years]. Follow‐up MRI was performed at a median of 5.5 months (interquartile range 2.5–6.0) after LIFT. At baseline, all patients showed a tract with predominantly granulation tissue, which changed to predominantly fibrotic in seven (in three of whom it was completely fibrotic). All patients with a (predominantly) fibrotic tract had clinical closure and no re‐interventions or recurrences during long‐term follow‐up. In contrast, of the five patients with persisting granulation tissue, two reached clinical healing, two needed re‐intervention and one had a recurrence. Conclusion Markedly decreased fistula activity can be observed on MRI after LIFT. The majority of patients develop a predominantly fibrotic tract relatively soon after LIFT without clinical recurrence, suggesting a highly effective therapy. Unfavourable clinical outcomes were only present in patients with persisting granulation tissue, indicating the potential prognostic value of MRI.

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“… 15–18 Generally, a completely fibrotic tract is considered as radiological healing. 15 , 17 Although it has been shown that a completely fibrotic tract is associated with a longer flare-fee period, 17 one can speculate that a largely but not completely fibrotic tract at imaging may be the representation of a possibly irreversible process of fibrosis development. Therefore, a largely fibrotic tract may have a similar predictive value for future long-term closure comparable to that of completely fibrotic tracks.…”

Section: Introductionmentioning

confidence: 99%

Fibrosis and MAGNIFI-CD Activity Index at Magnetic Resonance Imaging to Predict Treatment Outcome in Perianal Fistulizing Crohn’s Disease Patients

Rijn

Praag

Bossuyt

et al. 2021

Journal of Crohn's and Colitis

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Background and aims Characteristic MRI features associated with long-term perianal fistula closure are still being discussed. This study evaluated the predictive value of degree of fibrosis and disease activity (MAGNIFI-CD index) at MRI for long-term clinical closure of Crohn’s perianal fistulas. Methods Crohn’s disease (CD) patients treated with surgical closure following anti-TNF induction or anti-TNF alone for high perianal fistulas as part of a patient preference RCT (PISA-II) between 2013-2020 with a post-treatment MRI and long-term clinical follow-up data were retrospectively included. Two radiologists scored the degree of fibrosis and MAGNIFI-CD index at pre- and post-treatment MRI. The accuracy of post-treatment MRI findings in predicting long-term clinical closure (12 months after the MRI) was evaluated using receiver operating characteristics (ROC) analysis. Results Fifty patients were included; 31 female, median age 33 years (IQR 26-45). Fourteen patients showed a 100% fibrotic fistula at post-treatment MRI, all of which had long-term clinical closure. Median MAGNIFI-CD index at post-treatment MRI was 0 (IQR 0-5) in 25 patients with long-term clinical closure and 16 (IQR 10-20) in 25 patients without. ROC analysis showed an area under the curve of 0.90 (95%-CI 0.82-0.99) for degree of fibrosis and 0.95 (95%-CI 0.89-1.00) for the MAGNIFI-CD index, Youden cut-off point of six (91% specificity, 87% sensitivity). Conclusions Degree of fibrosis and MAGNIFI-CD index at post-treatment MRI are accurate in predicting long-term clinical closure and seem valuable in follow-up of perianal CD. A completely fibrotic tract at MRI is a robust indicator for long-term fistula closure.

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Deep remission on magnetic resonance imaging impacts outcomes of perianal fistulizing Crohn’s disease

Cited by 29 publications

References 35 publications

Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease: Results of the HOT‐TOPIC trial after 1‐year follow‐up

Hyperbaric oxygen therapy for the treatment of perianal fistulas in 20 patients with Crohn's disease: Results of the HOT‐TOPIC trial after 1‐year follow‐up

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

Fibrosis and MAGNIFI-CD Activity Index at Magnetic Resonance Imaging to Predict Treatment Outcome in Perianal Fistulizing Crohn’s Disease Patients

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