De Gregorio Michael, Winata Leon S, Hartley Imogen, Behrenbruch Corina C, Connor Susan J, D'Souza Basil, Basnayake Chamara, Guerra Glen R, Johnston Michael J, Kamm Michael A, Keck James O, Lust Mark, Niewiadomski Ola, Ong Eugene J S, Schulberg Julien D, Srinivasan Ashish, Sutherland Tom, Woods Rodney J, Wright Emily K, Connell William R, Thompson Alexander J, Ding Nik S
Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
J Crohns Colitis. 2025 Jan 11;19(1). doi: 10.1093/ecco-jcc/jjae199.
Crohn's perianal fistula healing rates remain low. We evaluated the efficacy of a protocolized multidisciplinary treatment strategy optimizing care in adults with Crohn's perianal fistulas.
A new treatment strategy was established at a single tertiary center. The strategy comprised 3 dynamic stages of care directed toward achieving and maintaining fistula healing. Stage A, active disease, focused on early commencement and proactive escalation of biologic therapies and structured surgical reviews ensuring adequate fistula drainage and conditioning. Stage B, optimized disease with a seton in situ, focused on consideration for seton removal and appropriateness of definitive surgical closure and/or ablative techniques. Stage C, healed disease, focused on proactive care maintenance. Sixty patients were sequentially enrolled and prospectively followed for ≥12 months. Endpoints included clinical healing and radiologic remission in those with clinically active fistulas, and relapse in those with healed fistulas.
At baseline, 52% (n = 31) and 48% (n = 29) had clinically active and healed fistulas, respectively. For patients with clinically active fistulas, 71% achieved clinical healing after 22 months, with estimated healing rates of 39% and 84% at 1 and 2 years, respectively. Radiologic remission was achieved in 25%, significantly higher than baseline inclusion rates of 6%. For patients with healed fistulas, 7% experienced clinical relapse after 23 months, with no significant change in radiologic remission, 80% versus 86% at baseline.
A protocolized treatment strategy proactively optimizing care resulted in high rates of clinical healing and improved radiologic remission of Crohn's perianal fistulas. Controlled-matched studies are needed.
克罗恩病肛周瘘管的愈合率仍然很低。我们评估了一种优化治疗方案的多学科治疗策略对成人克罗恩病肛周瘘管的疗效。
在一家三级中心制定了一种新的治疗策略。该策略包括针对实现并维持瘘管愈合的3个动态治疗阶段。A阶段为疾病活动期，重点是早期启动和积极升级生物治疗，以及进行结构化的外科评估以确保瘘管充分引流和预处理。B阶段为疾病优化期，瘘管挂线在位，重点是考虑去除挂线以及确定性手术闭合和/或消融技术的适用性。C阶段为疾病愈合期，重点是积极维持治疗。连续纳入60例患者，并进行前瞻性随访≥12个月。终点指标包括临床活动瘘管患者的临床愈合和影像学缓解，以及愈合瘘管患者的复发情况。
基线时，分别有52%（n = 31）和48%（n = 29）的患者有临床活动瘘管和愈合瘘管。对于有临床活动瘘管的患者，22个月后71%实现了临床愈合，1年和2年的估计愈合率分别为39%和84%。25%的患者实现了影像学缓解，显著高于基线纳入率6%。对于愈合瘘管的患者，23个月后7%出现临床复发，影像学缓解无显著变化，基线时为80%，随访时为86%。
一种积极优化治疗的方案化治疗策略使克罗恩病肛周瘘管的临床愈合率很高，并改善了影像学缓解情况。需要进行对照匹配研究。
