P0792 Remission rates in Complex Perianal Fistulizing Crohn's Disease – Real-life experience of a tertiary reference center
Authors: Silva A , Silva E , Brandão P , Sampaio M , Pedroto I , Santos M D , Lago P 
Published: January 2025

Background

The treatment of complex perianal fistula (cPF) in Crohn’s Disease (CD) requires an integrated and multidisciplinary approach (1) This phenotype affects up to a third of CD patients (2,3) and significantly harms their quality of life (4). This study aims to review the experience of a tertiary reference center and identify prognostic factors related to non-response to treatment.

Methods

Adult patients with CD who underwent surgery for cPF, in a tertiary reference center, between 2015 and 2023 were retrospectively reviewed. Extracted data included baseline demographic data, clinical recurrence of perianal disease, and resolution of perianal disease. Cases were stratified according to clinical response to treatment of perianal disease after surgery: complete clinical response (clinical remission), partial clinical response, clinical nonresponse or clinical recurrence.

Results

Seventy-nine patients (50.6% male) were included; the average age was 28 years (Q1=21 and Q3=38). Median follow-up of 85 months (interquartile range, 37-124); the multidisciplinary team discussed all of them. At the time of first surgery, 53.2% of patients had trans-sphincteric cPF, 22.8% had supra-sphincteric cPF, and 15.2% had rectovaginal cPF. In 88.6% of patients, the first procedure was seton placement. All but two patients were treated with 1 to 4 biologic drugs. The two patients treated with mesenchymal stem cells transplantation achieved a complete clinical response at 24 weeks, maintained at 52 weeks of follow-up. Female sex was a protective factor for nonresponse to treatment, and supra-esfincteric fistula was factor associated with the risk of nonresponse or recurrence. At end of follow-up, 78.5% of patients had a complete or partial response, and 21.5% had a nonresponse or a recurrence. Due to perineal destruction 3 patients required an ostomy, and the other 3 a proctectomy.

Conclusion

This real-life study showed that a multidisciplinary approach, including surgical intervention, can completely heal Crohn's disease perianal fistula in more than seventy-eight percent of patients. Supra-esphincteric fistula was a risk factor for worse disease outcomes, and female sex was a protective factor for nonresponse.

References

1.Devi J, Ballard DH, Aswani-Omprakash T, Parian AM, Deepak P. Current perspectives on diagnosis, monitoring and management with a focus on emerging therapies. Indian J Gastroenterol. 2024;43(1):48-63.

2.Schwartz DA, Loftus EV Jr, Tremaine WJ, et al. The natural history of fistulizing Crohn’s disease in Olmsted County, Minnesota. Gastroenterology. 2002;122:875–80.

3.Stevens TW, D’Haens GR, Duijvestein M, et al. Diagnostic accuracy of faecal calprotectin in patients with active perianal fistulas. United European Gastroenterol J. 2019;7:496-506.

4.Adegbola SO, Dibley L, Sahnan K, et al. Burden of disease and adaptation to life in patients with Crohn’s perianal fistula: a qualitative exploration. Health Qual Life Outcomes. 2020;18:1-13.