Hartley Imogen, Sarraf Babak, Wilding Helen, Segal Jonathan P, Ding Nik Sheng
Department of Gastroenterology, St Vincent's Hospital, Melbourne, Victoria, Australia.
Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia.
J Dig Dis. 2025 May;26(5-6):180-192. doi: 10.1111/1751-2980.13354. Epub 2025 Jun 15.
Perianal fistulizing Crohn's disease (pfCD) is a severe type of inflammatory bowel disease resulting in significant patient morbidity. Despite advancements in treatments, pfCD remains challenging to manage with low healing rates. Fecal diversion (FD) has previously demonstrated clinical improvement for patients with refractory disease. Our meta-analysis aimed to explore the clinical response to FD, rates of successful restoration of bowel continuity after FD, rates of re-diversion, and factors affecting the success of FD in pfCD.
A systematic review and meta-analysis was carried out of adult patients who had undergone FD for pfCD, with detailed patient outcome data. Studies were identified through a literature search of six bibliographic databases and one trial register, all run on February 28, 2025, including MEDLINE ALL, EMBASE, Emcare, APA PsycInfo, CINAHL, Cochrane Library, and Clinicaltrials.gov.
Seventeen studies encompassing 714 adult pfCD patients were included. FD resulted in a 65% clinical improvement rate, yet considerable heterogeneity existed in study methodologies and outcome definitions. While 29% of patients achieved bowel restoration within a median follow-up of 58.2 months, challenges in sustaining the effects were evident, with 10% requiring repeat diversion and a 37% overall proctectomy/proctocolectomy rate. Factors associated with diversion success included the absence of rectal involvement and quiescent luminal disease, with biologic use showing no impact on outcomes.
FD offers symptom control in pfCD, although restoration rates remain low. These findings emphasize the need for individualized patient counseling. Future research should strive for uniform measures and refined approaches to enhance pfCD management.
肛周瘘管型克罗恩病（pfCD）是一种严重的炎症性肠病，会导致患者出现明显的发病情况。尽管治疗方法有所进步，但pfCD的管理仍具有挑战性，愈合率较低。粪便转流（FD）此前已证明对难治性疾病患者有临床改善作用。我们的荟萃分析旨在探讨FD的临床反应、FD后肠道连续性成功恢复的比率、再次转流的比率以及影响pfCD中FD成功的因素。
对接受FD治疗的成年pfCD患者进行了系统评价和荟萃分析，并获取了详细的患者结局数据。通过对六个文献数据库和一个试验注册库进行文献检索来确定研究，检索均在2025年2月28日进行，包括MEDLINE ALL、EMBASE、Emcare、APA PsycInfo、CINAHL、Cochrane图书馆和Clinicaltrials.gov。
纳入了17项研究，共714例成年pfCD患者。FD使临床改善率达到65%，但研究方法和结局定义存在相当大的异质性。虽然29%的患者在中位随访58.2个月内实现了肠道恢复，但维持效果存在挑战，10%的患者需要再次转流，总体直肠切除术/直肠结肠切除术率为37%。与转流成功相关的因素包括无直肠受累和静止的腔内疾病，生物制剂的使用对结局无影响。
FD可控制pfCD的症状，尽管恢复率仍然较低。这些发现强调了对患者进行个体化咨询的必要性。未来的研究应努力采用统一的措施和优化的方法来加强pfCD的管理。
