Conditions: Crohn Disease Rectal Fistula
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 21
Healthy volunteers: no

Brief summary:
This study is to assess whether utilizing endoscopic ultrasound(EUS) to guide treatment can improve durable fistula healing in patients with Crohn's perianal fistulas and to get preliminary information regarding the effectiveness of Adalimumab for Crohn's perianal fistulas.

Detailed description:
Prospective randomized trial to assess the effectiveness of rectal EUS to guide perianal fistula treatment. Our hypothesis is that using imaging, in this case endoscopic ultrasound (EUS), to initially evaluate and then guide therapy with an anti-TNF agent (adalimumab) for fistulizing disease will lead to better short- and long-term outcomes.

Arms:
arm 1: Patients will be randomized to adalimumab treatment with EUS guided therapy decisions. Colorectal surgeon will have access to EUS data prior to EUA with possible seton placement. arm 2: Patients will be randomized to adalimumab treatment. Colorectal surgeon will not have access to EUS data prior to EUA with possible seton placement.

Interventions: intervention 1: EUA with seton placement if necessary intervention 2: adalimumab intervention 3: EUS
Intervention descriptions: intervention 1: Patients randomized to the combination therapy group, the surgeon will have access to EUS findings. intervention 2: Patients began therapy with adalimumab using clinic standards for dosing. intervention 3: Patients in combination therapy group had an EUS done every 12 weeks to help guide therapy.

Protocol document: