Min Young Park1, Yong Sik Yoon2, Jong Lyul Lee1, Sang Hyoung Park3, Byong Duk Ye3, Suk-Kyun Yang3, Chang Sik Yu1. 1. Department of Colon and Rectal Surgery, Asan Medical Center, University of College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. 2. Department of Colon and Rectal Surgery, Asan Medical Center, University of College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea. yoonys@amc.seoul.kr. 3. Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Abstract
BACKGROUND: Perianal fistula is one of the most common complications in Crohn's disease, and various medical and surgical treatments are being tried. The aim of this study was to compare the perianal fistula closure rates following treatment with anti-tumor necrosis factor (TNF) agents or autologous adipose tissue-derived stem cell (auto-ASC) transplantation with Crohn's disease (CD). METHODS: CD patients who underwent seton placement for perianal fistula from January 2015 to December 2019 at a tertiary referral center were retrospectively reviewed. Patients were divided into two groups, one that received sequential treatments with anti-TNF agents (anti-TNF group) and the other that underwent auto-ASC transplantation (stem cell group). Clinical variables and fistula closure rates were compared in the two groups. RESULTS: Of the 69 patients analyzed, 39 were treated with anti-TNF agents and 30 underwent auto-ASC transplantation. Compared with the stem cell group, patients in the anti-TNF group were older (p=0.028), were more frequently male (p=0.019), had fistulas with more penetrating behavior (p=0.002), had undergone surgery more frequently (p=0.010), and had a shorter interval from seton placement to intended treatment (p<0.001). During a median follow-up of 46 months (range, 30-52.5 months), fistula closure rates were significantly faster (83.3% vs. 23.1%, p<0.001), and the mean interval from seton placement to fistula closure significantly shorter (14 vs. 37 months, p<0.001) in the stem cell than in the anti-TNF group. Three patients experienced fistula recurrence, all in the stem cell group. CONCLUSIONS: Medical treatment using anti-TNF agents and auto-ASC transplantation are feasible treatment options after seton placement for Crohn's perianal fistula. However, the closure rate was significantly faster and the time to closure significantly shorter in patients who underwent auto-ASC transplantation than medical treatment. TRIAL REGISTRATION: This study was retrospectively registered and approved by the Institutional Review Board of Asan Medical Center, number 2020-1059 .
BACKGROUND: Perianal fistula is one of the most common complications in Crohn's disease, and various medical and surgical treatments are being tried. The aim of this study was to compare the perianal fistula closure rates following treatment with anti-tumor necrosis factor (TNF) agents or autologous adipose tissue-derived stem cell (auto-ASC) transplantation with Crohn's disease (CD). METHODS: CD patients who underwent seton placement for perianal fistula from January 2015 to December 2019 at a tertiary referral center were retrospectively reviewed. Patients were divided into two groups, one that received sequential treatments with anti-TNF agents (anti-TNF group) and the other that underwent auto-ASC transplantation (stem cell group). Clinical variables and fistula closure rates were compared in the two groups. RESULTS: Of the 69 patients analyzed, 39 were treated with anti-TNF agents and 30 underwent auto-ASC transplantation. Compared with the stem cell group, patients in the anti-TNF group were older (p=0.028), were more frequently male (p=0.019), had fistulas with more penetrating behavior (p=0.002), had undergone surgery more frequently (p=0.010), and had a shorter interval from seton placement to intended treatment (p<0.001). During a median follow-up of 46 months (range, 30-52.5 months), fistula closure rates were significantly faster (83.3% vs. 23.1%, p<0.001), and the mean interval from seton placement to fistula closure significantly shorter (14 vs. 37 months, p<0.001) in the stem cell than in the anti-TNF group. Three patients experienced fistula recurrence, all in the stem cell group. CONCLUSIONS: Medical treatment using anti-TNF agents and auto-ASC transplantation are feasible treatment options after seton placement for Crohn's perianal fistula. However, the closure rate was significantly faster and the time to closure significantly shorter in patients who underwent auto-ASC transplantation than medical treatment. TRIAL REGISTRATION: This study was retrospectively registered and approved by the Institutional Review Board of Asan Medical Center, number 2020-1059 .
Authors: Krisztina B Gecse; Willem Bemelman; Michael A Kamm; Jaap Stoker; Reena Khanna; Siew C Ng; Julián Panés; Gert van Assche; Zhanju Liu; Ailsa Hart; Barrett G Levesque; Geert D'Haens Journal: Gut Date: 2014-06-20 Impact factor: 23.059
Authors: Bruce E Sands; Frank H Anderson; Charles N Bernstein; William Y Chey; Brian G Feagan; Richard N Fedorak; Michael A Kamm; Joshua R Korzenik; Bret A Lashner; Jane E Onken; Daniel Rachmilewitz; Paul Rutgeerts; Gary Wild; Douglas C Wolf; Paul A Marsters; Suzanne B Travers; Marion A Blank; Sander J van Deventer Journal: N Engl J Med Date: 2004-02-26 Impact factor: 91.245
Authors: Choon Jin Ooi; Ida Hilmi; Rupa Banerjee; Sai Wei Chuah; Siew Chien Ng; Shu Chen Wei; Govind K Makharia; Pises Pisespongsa; Min Hu Chen; Zhi Hua Ran; Byong Duk Ye; Dong Il Park; Khoon Lin Ling; David Ong; Vineet Ahuja; Khean Lee Goh; Jose Sollano; Wee Chian Lim; Wai Keung Leung; Raja Affendi Raja Ali; Deng Chyang Wu; Evan Ong; Nazri Mustaffa; Julajak Limsrivilai; Tadakazu Hisamatsu; Suk Kyun Yang; Qin Ouyang; Richard Geary; Janaka H De Silva; Rungsun Rerknimitr; Marcellus Simadibrata; Murdani Abdullah; Rupert Wl Leong Journal: Intest Res Date: 2019-05-31