Department of Surgery, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
Colorectal Dis. 2021 Jan;23(1):169-177. doi: 10.1111/codi.15296. Epub 2020 Aug 29.
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.
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.
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.
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.
括约肌间瘘管结扎术（LIFT）越来越多地被用于克罗恩病高位肛周瘘的手术闭合。目前，关于术后 MRI 结果的数据很少，尽管它们被认为对评估愈合和复发很重要。因此，我们的目的是评估 LIFT 后 MRI 上的瘘管特征及其与临床结果的关系。
回顾性纳入 2007 年至 2018 年间接受 LIFT 治疗的连续克罗恩病患者，这些患者均接受了基线和随访 MRI。两名放射科医生根据原始和改良的 Van Assche 指数，根据特征对 MRI 进行评分。描述了 MRI 结果，重点是纤维化，并与临床愈合、再次干预和复发的关系。
共纳入 12 例患者（4 例男性，中位年龄 34 岁（四分位距 28-39 岁））。LIFT 后中位随访 MRI 时间为 5.5 个月（四分位距 2.5-6.0）。基线时，所有患者的瘘管均表现为以肉芽组织为主，7 例（其中 3 例完全纤维化）转变为以纤维组织为主。所有（主要）纤维化瘘管的患者均获得临床愈合，在长期随访中无再次干预或复发。相比之下，5 例持续存在肉芽组织的患者中，2 例达到临床愈合，2 例需要再次干预，1 例复发。
LIFT 后 MRI 可观察到瘘管活动明显减少。大多数患者在 LIFT 后不久即发展为以纤维组织为主的瘘管，且无临床复发，提示该治疗方法非常有效。只有在持续存在肉芽组织的患者中才出现不良的临床结局，这表明 MRI 具有潜在的预后价值。
