Predictors of reoperation for perianal fistula in Crohn's disease

Nam, Kwangwoo; Jung, Won Beom; Lee, Seung Bum; Soh, Jae Seung; Song, Yang; Jung, Seok Won

doi:10.1111/1751-2980.12996

Cited by 4 publications

(3 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Of these, 166 were included in the full text review. Seventy‐six were further excluded, leaving 90 studies for data extraction [17–106] (Figure 1). Of the 90 studies, there were 53 retrospective studies, 16 prospective observational studies, 16 RCTs, four case series and one cross‐sectional study.…”

Section: Resultsmentioning

confidence: 99%

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

Khan,

Arline,

Williams

et al. 2024

Colorectal Disease

View full text Add to dashboard Cite

AimThe heterogeneity in data quality presented in studies regarding Crohn's anal fistula (CAF) limit extrapolation into clinical practice. The ENiGMA collaborators established a core descriptor set to standardize reporting of CAF. The aim of this work was to quantify the use of these descriptors in recent literature.MethodWe completed a systematic review of PubMed and the Cochrane Library, extracting publications from the past 10 years specific to the clinical interventions and outcomes of CAF, and reported in line with PRISMA guidance. Each article was assessed for inclusion of ENiGMA descriptors. The median number of descriptors per publication was evaluated along with the overall frequency of each individual descriptor. Use of ENiGMA descriptors was compared between medical and procedural publications.ResultsNinety publications were included. The median number of descriptors was 15 of 37; 16 descriptors were used in over half of the publications while 17 were used in fewer than a third. Descriptors were more frequently used in procedural (n = 16) than medical publications (n = 14) (p = 0.031). In procedural publications, eight descriptors were more frequently used including Faecal incontinence, Number of previous fistula interventions, Presence and severity of anorectal stenosis and Current proctitis. Medical publications were more likely to include Previous response to biological therapy and Duration and type of current course of biological therapy.ConclusionWith many descriptors being used infrequently and variations between medical and procedural literature, the colorectal community should assess the need for all 37 descriptors.

show abstract

Section: Resultsmentioning

confidence: 99%

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

Khan,

Arline,

Williams

et al. 2024

Colorectal Disease

View full text Add to dashboard Cite

show abstract

“…If surgery is deemed necessary, surgery should be performed first before simply intensifying medical treatment. However, fistula relapse is common following perianal surgery [ 167 ], and evidence from at least one retrospective review suggests that drug escalation after initial surgery is associated with a significantly reduced likelihood of reoperation [ 168 ]. In patients treated with anti-TNFα therapy who have achieved a symptomatic response, ongoing reassessment is needed to determine if treatment can be maintained at the same level or if the dose of anti-TNFα agent should be increased.…”

Section: Consensus Recommendationsmentioning

confidence: 99%

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

et al. 2023

View full text Add to dashboard Cite

Background We aimed to develop criteria for treatment intensification in patients with (1) luminal Crohn’s disease (CD), (2) CD with perianal disease and/or fistula, (3) CD with small bowel stenosis, (4) in the postoperative setting, and (5) for discontinuing or reducing the dose of treatment in patients with CD. Methods PubMed and Embase were searched for studies published since 1998 which may be relevant to the five defined topics. Results were assessed for relevant studies, with preference given to data from randomized, controlled studies. For each question, a core panel of 12 gastroenterologists defined the treatment target and developed statements, based on the literature, current guidelines, and relevant additional studies. The evidence supporting each statement was graded using the Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). A modified Delphi process was used to refine statements and gain agreement from 54 Japanese specialists at in-person and online meetings conducted between October 2020 and April 2021. Results Seventeen statements were developed for treatment intensification in luminal CD (targeting endoscopic remission), six statements for treatment intensification in perianal/fistulizing CD (targeting healing of perianal lesions and complete closure of the fistula), six statements for treatment intensification in CD with small bowel stenosis (targeting resolution of obstructive symptoms), seven statements for treatment intensification after surgery (targeting endoscopic remission), and five statements for discontinuing or reducing the dose of treatment in patients with CD. Conclusions These statements provide guidance on how and when to intensify or de-intensify treatment for a broad spectrum of patients with CD.

show abstract

“…Transmural inflammation of the gastrointestinal tract alternates between chronic remission and recurrence [ 3 ]. These characteristics leave patients with chronic immunosuppression and they need repeated surgery to treat the symptoms of the disease [ 4 , 5 ], but surgery cannot cure the disease [ 6 ]. More than a quarter of patients with CD develop perianal fistulizing Crohn’s disease (PFCD) [ 7 ], which has been treated with biologics and surgical procedures [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Internal Orifice Alloy Closure: A New Procedure for Treatment of Perianal Fistulizing Crohn’s Disease

Fang,

Deng,

2023

Med Sci Monit

View full text Add to dashboard Cite

Background The high recurrence rate of perianal fistula Crohn’s disease (PFCD) increases the need to protect the anal sphincter during each surgical treatment of fistulas. We aimed to evaluate the safety and efficacy of internal orifice alloy closure in patients with PFCD. Material/Methods Fifteen patients with PFCD were enrolled in the study between July 6, 2021, and April 27, 2023. All patients underwent preoperative colonoscopy and anal magnetic resonance examination for diagnosis and evaluation. Internal orifice alloy closure (IOAC) was performed only when Crohn’s disease was in remission. The external sphincter had not been severed. Perianal magnetic resonance imaging examination was used for postoperative evaluation after 6 months. Fistula cure rate, length of stay, perianal pain, and Wexner incontinence score were retrospectively compared between 15 patients treated with IOAC and 40 patients treated with other surgical methods. Results Fifteen patients (male/female: 9/6, age: 23.6±14.3 years) with PFCD were included (follow-up: 24 months). In total, 20.0% (3) had multiple tracts, and 13.3% (2) had a high anal fistula. Among them, 10 patients received biologics for induction for mucosal healing before surgery. The fistula healed completely in 80.0% (12/15) and did not heal in 20.0% (3/15). Three patients who did not heal underwent fistulotomy and eventually recovered. IOAC is not superior in terms of fistula healing rates, length of stay, and anal pain, but its Wexner incontinence scores are significantly lower than with other surgical methods. Conclusions IOAC is a novel sphincter-saving surgery that is effective and safe for the treatment of PFCD.

show abstract

Predictors of reoperation for perianal fistula in Crohn's disease

Cited by 4 publications

References 28 publications

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

The use of core descriptors from the ENiGMA code study in recent literature: a systematic review

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

Internal Orifice Alloy Closure: A New Procedure for Treatment of Perianal Fistulizing Crohn’s Disease

Contact Info

Product

Resources

About