Salinas Gregory David, Belcher Emily, Stacy Sylvie, Nazarey Pradeep P, Cazzetta Susan E
CE Outcomes, Birmingham, Alabama, USA
CE Outcomes, Birmingham, Alabama, USA.
BMJ Open Gastroenterol. 2025 May 11;12(1):e001711. doi: 10.1136/bmjgast-2024-001711.
A case-based survey was conducted to identify practice patterns and knowledge gaps in the management of Crohn's perianal fistulas (CPF) and to further understand approaches to CPF management within the USA by healthcare professionals (HCPs) from different specialties.
The web-based survey, comprising two hypothetical patient case vignettes (case 1: initial CPF presentation and progression to partial response; case 2: recurrent CPF), was distributed September-October 2020 to US gastroenterologists (GEs) and colorectal surgeons (CRSs), and nurse practitioners (NPs) and physician assistants (PAs) from these specialties, who managed ≥1 patient with CPF/month. The survey included questions on clinician evaluation and treatment approach.
Across surveyed HCPs (127 GEs, 63 GE NP/PAs, 78 CRSs and 14 CRS NP/PAs), 39% stated that they did not use any standard system for classifying/scoring CPF. On initial CPF presentation, ≥98% of HCPs reported a requirement for additional diagnostic/imaging evaluation before proceeding with medical management; GEs preferred pelvic MRI (70%) and CRSs preferred examination under anaesthesia (62%). Preferred management after partial response to initial treatment varied by HCP type (23% GEs vs 71% CRSs preferred continuation of current medical therapy; 60% vs 38% preferred seton continuation; 24% vs 41% preferred seton removal, respectively). For recurrent CPF, most HCPs chose to switch from infliximab to another antitumour necrosis factor agent, while most GEs opted to switch to a different monoclonal antibody. In contrast, 44% of GEs and 27% of CRSs opted to proceed with surgery.
Lack of consensus in CPF management requires improved coordination in treatment approaches among specialists.
开展一项基于病例的调查，以确定克罗恩病肛周瘘管（CPF）管理中的实践模式和知识差距，并进一步了解美国不同专业的医疗保健专业人员（HCP）对CPF管理的方法。
基于网络的调查于2020年9月至10月发放给美国胃肠病学家（GE）、结直肠外科医生（CRS）以及这些专业的执业护士（NP）和医师助理（PA），他们每月管理≥1例CPF患者。该调查包含两个假设的患者病例 vignettes（病例1：CPF初次出现并进展为部分缓解；病例2：复发性CPF）。调查包括有关临床医生评估和治疗方法的问题。
在接受调查的HCP中（127名GE、63名GE NP/PA、78名CRS和14名CRS NP/PA），39%表示他们没有使用任何标准系统对CPF进行分类/评分。在CPF初次出现时，≥98%的HCP报告在进行药物治疗之前需要额外的诊断/影像评估；GE更喜欢盆腔MRI（70%），CRS更喜欢麻醉下检查（62%）。初次治疗部分缓解后的首选管理方法因HCP类型而异（23%的GE与71%的CRS更喜欢继续当前的药物治疗；60%对38%更喜欢继续放置引流管；24%对41%更喜欢移除引流管）。对于复发性CPF，大多数HCP选择从英夫利昔单抗换用另一种抗肿瘤坏死因子药物，而大多数GE选择换用不同的单克隆抗体。相比之下，44%的GE和27%的CRS选择进行手术。
CPF管理缺乏共识需要专家之间改善治疗方法的协调。
