Results of the Fifth Scientific Workshop of the ECCO [II]: Clinical Aspects of Perianal Fistulising Crohn’s Disease—the Unmet Needs

Abstract

The treatment of perianal fistulising Crohn's disease remains a multidisciplinary challenge. To optimise management, a reliable classification and proper trial endpoints are needed. This could lead to standardised diagnosis, treatment, and follow-up of Crohn's perianal fistulas and the execution of well-designed trials that provide clear answers. The prevalence and the natural history of pCD need further evaluation.

The role of multimodal treatment in Crohn′s disease patients with perianal fistula: a multicentre retrospective cohort study

“…Due to a lack of evidence, the optimal management of perianal disease is still poorly defined . Surgical intervention at presentation is indispensable for a majority of patients with CD‐pAF mainly for drainage of symptomatic abscesses and insertion of seton .…”

“…Moreover, despite the introduction of multiple newer effective therapies for luminal CD, CD‐pAF patients even now present challenging clinical scenarios by either failing to respond to the therapeutic approaches or failing to sustain responses in those who initially improve following therapies such as anti‐tumour necrosis factor alpha agents (anti‐TNFs) . Hence, management approaches for CD‐pAF patients remain one of the major unmet needs in CD …”

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

“…Both subjects have been the subject of recent commissioned calls from the National Institute of Health Research Health Technology Assessment, although there are no nationally funded studies yet. The ECCO ran a workshop in unmet research needs in perianal Crohn's disease and identified the natural history of perianal Crohn's disease, classification of fistula tracks, clinical, patient-reported and MRI outcome measures and lack of randomized controlled trials as major research gaps [81]. The latter concern is partly met by the ongoing PISA trial in fistulating perianal Crohn's disease that offers randomization among three arms of (i) standard care with long-term seton placement and oral immunosuppression, (ii) biological therapy with timed seton removal and (iii) seton drainage with limited biological therapy and then advancement flap [82].…”

Review article: pathogenesis of Crohn's perianal fistula—understanding factors impacting on success and failure of treatment strategies

“…An ECCO consensus group recently identified a "comprehensive classification" as an unmet need in pCD management. 9 Studies of medical and surgical interventions for Crohn's (and sphincter preserving procedures in non-Crohn's) anal fistulae consistently agree that there is currently no gold standard treatment with a high success rate. However, multidisciplinary management remains crucial to ensure patients are able to benefit from the medical and surgical options available, and that they are fully informed about their own disease.…”

“…Classification can also be performed at a genetic level but similar work in Crohn's perianal fistula is lacking, in particular an intervention study in an inception cohort. An ECCO consensus group recently identified a “comprehensive classification” as an unmet need in pCD management …”