Surgical closure, mainly with glue injection and anti‐tumour necrosis factor α, in fistulizing perianal Crohn's disease: A multicentre randomized controlled trial

Abramowitz, Laurent; Brochard, Charlène; Pigot, F.; Roumeguère, P.; Pillant, Hélène; Bonnet, Béatrice; Faucheron, J.‐L.; Senéjoux, A.; Bonnaud, Guillaume; Meurette, G.; Fayette, Jean Marie; Train, Cécile; Staumont, G.; Siproudhis, L.; Bouchard, D.

doi:10.1111/codi.15947

Cited by 11 publications

(5 citation statements)

References 33 publications

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“…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%

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

Khan,

Arline,

Williams

et al. 2024

Colorectal Disease

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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.

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Section: Resultsmentioning

confidence: 99%

“…Of the 37 ENiGMA core descriptors, a median of 15 were presented per study (IQR [13][14][15][16][17][18]. Sixteen descriptors were used in over 50% of studies, while 17 or more descriptors were present in fewer than 33% of studies.…”

Section: Re Sultsmentioning

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

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“…55 Interestingly, a separate study of patients who had undergone seton placement followed by adalimumab induction also randomized patients to seton removal alone or removal plus fibrin glue injection, but found no difference in fistula closure rates between the groups at 1 year after surgery (65% vs. 56%, p ¼ 0.48). 56 Although small samples, variable patient populations, and contradictory evidence from randomized trials make definitive conclusions hard to draw, most colorectal surgeons view fibrin glue as a safe but generally ineffective option with limited risk to patients.…”

Section: Fibrin Gluementioning

confidence: 99%

Perianal Fistulizing Crohn's Disease: Outcomes of Surgical Repairs and Current State of Stem Cell-Based Therapies

Dawes,

Lightner

2024

Clin Colon Rectal Surg

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Perianal fistulizing Crohn's disease is one of the most disabling phenotypes of Crohn's disease, due to the severe impairment in quality of life including social and personal wellbeing. A multimodal approach with patient-tailored care is the key to optimal management of this condition. Medical therapy is needed to optimize the luminal disease, and surgical intervention is required to control any associated perianal sepsis and attempt palliative or definitive fistula repair. While several medical and surgical options are available, the majority of patients continue to have symptomatic disease. Fortunately, this continues to drive novel innovations which are revolutionizing the treatment and outcomes of perianal fistulizing Crohn's disease. However, there continues to be a need for randomized trials and consistent metrics utilized for classification and treatment outcomes in order to accurately describe optimal treatment outcomes.

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“…Another recent RCT compared seton removal plus surgical closure (79% had fibrin glue) to seton removal alone in 64 patients with perianal FCD treated with adalimumab. The fistula closure rate was not significant between the groups (surgical closure plus seton 56% vs. seton alone 65%) [ 119 ]. Of note, fibrin glue is not effective in patients with complex fistulas [ 136 ], even when combined with other modalities such as antibiotics [ 141 ].…”

Section: Surgical Management Of Fistulizing CDmentioning

confidence: 99%

The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials

Wetwittayakhlang

Khoury

Hahn

et al. 2022

JCM

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Fistulizing Crohn’s disease (FCD) remains the most challenging aspect of treating patients with CD. FCD can occur in up to 30% of patients with CD and may lead to significant disability and impaired quality of life. The optimal treatment strategies for FCD require a multidisciplinary approach, including a combined medical and surgical approach. The therapeutic options for FCD are limited due to sparse evidence from randomized clinical trials (RCTs). The current recommendations are mainly based on post hoc analysis from RCTs, real-world clinical studies and expert opinion. There is variation in everyday clinical practice amongst gastroenterologists and surgeons. The evidence for anti-tumor necrosis factor therapy is the strongest in the treatment of FCD. However, long-term fistula healing can be achieved in only 30–50% of patients. In recent years, emerging data in the advent of therapeutic modalities, including the use of new biologic agents, therapeutic drug monitoring, novel surgical methods and mesenchymal stem cell therapy, have been shown to improve outcomes in achieving fistula healing. This review summarizes the existing literature on current and emerging therapies to provide guidance beyond RCTs in managing FCD.

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Surgical closure, mainly with glue injection and anti‐tumour necrosis factor α, in fistulizing perianal Crohn's disease: A multicentre randomized controlled trial

Cited by 11 publications

References 33 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

Perianal Fistulizing Crohn's Disease: Outcomes of Surgical Repairs and Current State of Stem Cell-Based Therapies

The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials

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