White Ian, Karki Chitra, Geransar Parnia, Leisle Lilia, Junker Sophia, Fleshner Phillip
Department of Surgery, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel.
Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Inflamm Bowel Dis. 2025 Jun 13;31(6):1556-1566. doi: 10.1093/ibd/izae186.
Optimal treatment strategies for seton use in patients with Crohn's perianal fistulas (CPF) remain elusive. This systematic literature review aimed to summarize clinical, patient-reported, and healthcare resource utilization (HCRU) outcomes associated with seton use for symptomatic relief and treatment of complex CPF.
Electronic databases (MEDLINE, Embase, EBM Reviews, EconLit) were searched. Titles, abstracts, and relevant full texts were screened by 2 reviewers for inclusion using prespecified PICOS-T criteria. Articles published in English between January 1, 1980 and September 6, 2021 were included; animal/in vitro studies and case reports with <5 patients were excluded. Outcomes of interest included rates of complete response/remission and fistula recurrence in patients receiving seton with/without infliximab or biologics. Data were summarized using descriptive statistics.
Overall, 56 studies were included (full texts: n = 43; congress abstracts: n = 13). CPF and clinical outcome definitions were heterogeneous. Rates (range) of complete response/remission varied widely (seton: 13%-75%; seton + infliximab: 23%-100%; seton + biologics: 23%-59%) as did rates for fistula recurrence (seton: 4%-68%; seton + infliximab: 0%-50%; seton + biologics: 0%-17%). Rates of fistula-related reintervention, new fistula or abscess formation, and abscess recurrence were also varied; more consistency was observed regarding the use of patient-reported outcomes. Few studies reported outcomes from pediatric/adolescent patients or HCRU.
Optimal use of seton in patients with CPF remains unclear. International standardization of definitions for CPF and related clinical outcomes are required to permit data comparability and identify the most effective treatment strategies involving seton use in CPF.
用于克罗恩病肛周瘘管（CPF）患者的挂线疗法的最佳治疗策略仍不明确。本系统文献综述旨在总结与使用挂线疗法缓解症状和治疗复杂性CPF相关的临床、患者报告及医疗资源利用（HCRU）结果。
检索电子数据库（MEDLINE、Embase、循证医学评价、经济文献数据库）。由两名审阅者根据预先设定的PICOS-T标准筛选标题、摘要及相关全文以纳入研究。纳入1980年1月1日至2021年9月6日期间发表的英文文章；排除动物/体外研究以及患者人数少于5例的病例报告。感兴趣的结果包括接受挂线疗法联合或不联合英夫利昔单抗或生物制剂的患者的完全缓解/缓解率及瘘管复发率。数据采用描述性统计进行总结。
总体而言，共纳入56项研究（全文：n = 43；会议摘要：n = 13）。CPF及临床结局定义各异。完全缓解/缓解率（范围）差异很大（挂线疗法：13% - 75%；挂线疗法 + 英夫利昔单抗：23% - 100%；挂线疗法 + 生物制剂：23% - 59%），瘘管复发率也是如此（挂线疗法：4% - 68%；挂线疗法 + 英夫利昔单抗：0% - 50%；挂线疗法 + 生物制剂：0% - 17%）。瘘管相关再次干预、新瘘管或脓肿形成以及脓肿复发率也各不相同；在患者报告结局的使用方面观察到更多的一致性。很少有研究报告儿科/青少年患者或HCRU的结果。
CPF患者挂线疗法的最佳应用仍不明确。需要对CPF及相关临床结局的定义进行国际标准化，以实现数据的可比性，并确定涉及CPF挂线疗法的最有效治疗策略。
