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Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience

Year 2016, Volume: 29 Issue: 2, 79 - 83, 01.04.2016
https://doi.org/10.5472/MMJoa.2902.03

Abstract

Objective: The aim of this study was to evaluate the efficacy of combined treatment with anti-tumor necrosis factor (TNF) agents, and setons for perianal fistulas in Crohn’s disease.Patients and Methods: Study included 27 consecutive patients with perianal fistulizing Crohn’s disease, requiring seton drainage and anti-TNF therapy in our center from January 2013 to November 2014. All patients underwent a standardized pelvic magnetic resonance imaging (MRI) examination. Patient characteristics, follow up time, findings of pelvic MRI, colonoscopy and examination under anesthesia findings were recorded. Response to treatment was evaluated at the end of the follow up.Results: The median follow-up after treatment was 17 months (6-32). The fistula was complex in 24 (89%) of the 27 patients. Colonoscopy revealed ileitis in 16 (59.3%) patients and active proctitis in 9 (33.3%) patients. Perianal abscess was observed in12 (44.4%) patients. Complete response was obtained in 17 (63%) patients. Only 3 (11.1%) patients experienced recurrence abscess during the study period. We could not find any factor, which were associated with complete response.Conclusion: Complete response was achieved in 63% of the patients, with perianal fistula formation associated with Crohn’s disease, with combined seton drainage and anti-TNF therapy.Keywords: Crohn’s disease, Perianal fistula, Setons, Infliximab

References

  • Molendijk I, Peeters KC, Baeten CI, Veenendaal RA, van der Meulen-de Jong AE. Improving the outcome of fistulising Crohn’s disease. Best Pract Res Clin Gastroenterol 2014; 28: 505-18. doi: 10.1016/j.bpg.2014.04.011.
  • Kamm MA, Ng SC. Perianal fistulizing Crohn’s disease: a call to action. Clin Gastroenterol Hepatol 2008 ; 6: 7–10.
  • Van Assche G, Dignass A, Reinisch W, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: special situations. J Crohn’s Colitis 2010; 4: 63–101. doi:10.1016/j.crohns.2009.09.009
  • Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB. AGA technical review on perianal Crohn’s disease. Gastroenterology 2003; 125: 1508–30.
  • Lunniss PJ, Armstrong P, Barker PG, Reznek RH, Phillips RK. Magnetic resonance imaging of anal fistulae. Lancet 1992; 15: 394–6.
  • Orsoni P, Barthet M, Portier F, Panuel M, Desjeux A, Grimaud JC. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn’s disease. Br J Surg 1999; 86: 360–4.
  • Schwartz DA, Wiersema MJ, Dudiak KM, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 2001; 121: 1064–72.
  • Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg 1976; 63: 1–12.
  • Gecse K, Khanna R, Stoker J, et al. Fistulizing Crohn’s disease: Diagnosis and management. United European Gastroenterol J 2013; 1: 206-13. doi: 10.1177/2050640613487194
  • Yamamoto T, Allan RN, Keighley MRB. Effect of fecal diversion alone on perianal Crohn’s disease. World J Surg 2000; 24: 1258- 63.
  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 1999; 340: 1398–405.
  • Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 2004; 350: 876–85.
  • Da W, Zhu J, Wang L, Lu Y. Adalimumab for Crohn’s disease after infliximab treatment failure: a systematic review. Eur J Gastroenterol Hepatol 2013; 25: 885-91. doi: 10.1097/MEG.0b013e32836220ab
  • Rasul I, Wilson SR, MacRae H, Irwin S, Greenberg GR. Clinical and radiological responses after infliximab
  • treatment for perianal fistulizing Crohn’s disease. Am J Gastroenterol 2004; 99: 82-8.
  • Haennig A, Staumont G, Lepage B, et al. The results of seton drainage combined with anti TNFα therapy for anal fistula in Crohn’s disease. Colorectal Dis 2015; 17: 311-9.
  • Topstad DR, Panaccione R, Heine JA, Johnson DRE, MacLean AR, Buie WD. Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn’s disease. A single center experience. Dis Colon Rectum 2003; 46: 577–83.
  • Tougeron D, Savoye G, Savoye-Collet C, Koning E, Michot F, Lerebours E. Predicting factors of fistula healing and clinical remission after infliximab based combined therapy for perianal fistulizing Crohn’s disease. Dig Dis Sci 2009; 54:1746- 52.
  • Talbot C, Sagar PM, Johnston MJ, Finan PJ, Burke D. Infliximab in the surgical management of complex fistulating anal Crohn’s disease. Colorectal Dis 2005; 7: 164-8. doi: 10.1111/j.1463-1318.2004.00749.x
  • Hyder SA, Travis SP, Jewell DP, McC Mortensen NJ, George BD. Fistulating anal Crohn’s disease: results of combined surgical and infliximab treatment. Dis Colon Rectum 2006; 49: 1837-41.
  • Guidi L, Ratto C, Semeraro S, et al. Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn’s disease with anal endosonographic monitoring: a single-centre experience. Tech Coloproctol 2008; 12: 111-7.
  • Bouguen G, Trouilloud I, Siproudhis L, et al. Long-term outcome of non-fistulizing (ulcers, stricture) perianal Crohn’s disease in patients treated with infliximab. Aliment Pharmacol Ther 2009; 30: 749-56.
  • Duff S, Sagar PM, Rao M, Dolling S, Sprakes M, Hamlin PJ. Infliximab and surgical treatment of complex anal Crohn’s disease. Colorectal Dis 2012; 14: 972-6.
  • Antakia R, Shorthouse AJ, Robinson K, Lobo AJ. Combined modality treatment for complex fistulating perianal Crohn’s disease. Colorectal Dis 2013; 15: 210-6.
  • Bouguen G, Siproudhis L, Gizard E, et al. Long-term outcome of perianal fistulizing Crohn’s disease treated with infliximab. Clin Gastroenterol Hepatol 2013; 11: 975-81. doi: 10.1016/j.cgh.2012.12.042.

Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience

Year 2016, Volume: 29 Issue: 2, 79 - 83, 01.04.2016
https://doi.org/10.5472/MMJoa.2902.03

Abstract

Objective: The aim of this study was to evaluate the efficacy of combined treatment with anti-tumor necrosis factor (TNF) agents, and setons for perianal fistulas in Crohn’s disease.Patients and Methods: Study included 27 consecutive patients with perianal fistulizing Crohn’s disease, requiring seton drainage and anti-TNF therapy in our center from January 2013 to November 2014. All patients underwent a standardized pelvic magnetic resonance imaging (MRI) examination. Patient characteristics, follow up time, findings of pelvic MRI, colonoscopy and examination under anesthesia findings were recorded. Response to treatment was evaluated at the end of the follow up.Results: The median follow-up after treatment was 17 months (6-32). The fistula was complex in 24 (89%) of the 27 patients. Colonoscopy revealed ileitis in 16 (59.3%) patients and active proctitis in 9 (33.3%) patients. Perianal abscess was observed in12 (44.4%) patients. Complete response was obtained in 17 (63%) patients. Only 3 (11.1%) patients experienced recurrence abscess during the study period. We could not find any factor, which were associated with complete response.Conclusion: Complete response was achieved in 63% of the patients, with perianal fistula formation associated with Crohn’s disease, with combined seton drainage and anti-TNF therapy.Keywords: Crohn’s disease, Perianal fistula, Setons, Infliximab

References

  • Molendijk I, Peeters KC, Baeten CI, Veenendaal RA, van der Meulen-de Jong AE. Improving the outcome of fistulising Crohn’s disease. Best Pract Res Clin Gastroenterol 2014; 28: 505-18. doi: 10.1016/j.bpg.2014.04.011.
  • Kamm MA, Ng SC. Perianal fistulizing Crohn’s disease: a call to action. Clin Gastroenterol Hepatol 2008 ; 6: 7–10.
  • Van Assche G, Dignass A, Reinisch W, et al. The second European evidence-based consensus on the diagnosis and management of Crohn’s disease: special situations. J Crohn’s Colitis 2010; 4: 63–101. doi:10.1016/j.crohns.2009.09.009
  • Sandborn WJ, Fazio VW, Feagan BG, Hanauer SB. AGA technical review on perianal Crohn’s disease. Gastroenterology 2003; 125: 1508–30.
  • Lunniss PJ, Armstrong P, Barker PG, Reznek RH, Phillips RK. Magnetic resonance imaging of anal fistulae. Lancet 1992; 15: 394–6.
  • Orsoni P, Barthet M, Portier F, Panuel M, Desjeux A, Grimaud JC. Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn’s disease. Br J Surg 1999; 86: 360–4.
  • Schwartz DA, Wiersema MJ, Dudiak KM, et al. A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn’s perianal fistulas. Gastroenterology 2001; 121: 1064–72.
  • Parks AG, Gordon PH, Hardcastle JD. A classification of fistula-in-ano. Br J Surg 1976; 63: 1–12.
  • Gecse K, Khanna R, Stoker J, et al. Fistulizing Crohn’s disease: Diagnosis and management. United European Gastroenterol J 2013; 1: 206-13. doi: 10.1177/2050640613487194
  • Yamamoto T, Allan RN, Keighley MRB. Effect of fecal diversion alone on perianal Crohn’s disease. World J Surg 2000; 24: 1258- 63.
  • Present DH, Rutgeerts P, Targan S, et al. Infliximab for the treatment of fistulas in patients with Crohn’s disease. N Engl J Med 1999; 340: 1398–405.
  • Sands BE, Anderson FH, Bernstein CN, et al. Infliximab maintenance therapy for fistulizing Crohn’s disease. N Engl J Med 2004; 350: 876–85.
  • Da W, Zhu J, Wang L, Lu Y. Adalimumab for Crohn’s disease after infliximab treatment failure: a systematic review. Eur J Gastroenterol Hepatol 2013; 25: 885-91. doi: 10.1097/MEG.0b013e32836220ab
  • Rasul I, Wilson SR, MacRae H, Irwin S, Greenberg GR. Clinical and radiological responses after infliximab
  • treatment for perianal fistulizing Crohn’s disease. Am J Gastroenterol 2004; 99: 82-8.
  • Haennig A, Staumont G, Lepage B, et al. The results of seton drainage combined with anti TNFα therapy for anal fistula in Crohn’s disease. Colorectal Dis 2015; 17: 311-9.
  • Topstad DR, Panaccione R, Heine JA, Johnson DRE, MacLean AR, Buie WD. Combined seton placement, infliximab infusion, and maintenance immunosuppressives improve healing rate in fistulizing anorectal Crohn’s disease. A single center experience. Dis Colon Rectum 2003; 46: 577–83.
  • Tougeron D, Savoye G, Savoye-Collet C, Koning E, Michot F, Lerebours E. Predicting factors of fistula healing and clinical remission after infliximab based combined therapy for perianal fistulizing Crohn’s disease. Dig Dis Sci 2009; 54:1746- 52.
  • Talbot C, Sagar PM, Johnston MJ, Finan PJ, Burke D. Infliximab in the surgical management of complex fistulating anal Crohn’s disease. Colorectal Dis 2005; 7: 164-8. doi: 10.1111/j.1463-1318.2004.00749.x
  • Hyder SA, Travis SP, Jewell DP, McC Mortensen NJ, George BD. Fistulating anal Crohn’s disease: results of combined surgical and infliximab treatment. Dis Colon Rectum 2006; 49: 1837-41.
  • Guidi L, Ratto C, Semeraro S, et al. Combined therapy with infliximab and seton drainage for perianal fistulizing Crohn’s disease with anal endosonographic monitoring: a single-centre experience. Tech Coloproctol 2008; 12: 111-7.
  • Bouguen G, Trouilloud I, Siproudhis L, et al. Long-term outcome of non-fistulizing (ulcers, stricture) perianal Crohn’s disease in patients treated with infliximab. Aliment Pharmacol Ther 2009; 30: 749-56.
  • Duff S, Sagar PM, Rao M, Dolling S, Sprakes M, Hamlin PJ. Infliximab and surgical treatment of complex anal Crohn’s disease. Colorectal Dis 2012; 14: 972-6.
  • Antakia R, Shorthouse AJ, Robinson K, Lobo AJ. Combined modality treatment for complex fistulating perianal Crohn’s disease. Colorectal Dis 2013; 15: 210-6.
  • Bouguen G, Siproudhis L, Gizard E, et al. Long-term outcome of perianal fistulizing Crohn’s disease treated with infliximab. Clin Gastroenterol Hepatol 2013; 11: 975-81. doi: 10.1016/j.cgh.2012.12.042.
There are 25 citations in total.

Details

Subjects Clinical Sciences
Other ID JA26GE73AN
Journal Section Review Makaleler
Authors

Samet Yardımcı This is me

Yalçın Burak Kara This is me

Wafi Attaallah This is me

Mustafa Ümit Uğurlu This is me

Şevket Cumhur Yeğen This is me

Publication Date April 1, 2016
Published in Issue Year 2016 Volume: 29 Issue: 2

Cite

APA Yardımcı, S., Kara, Y. B., Attaallah, W., Uğurlu, M. Ü., et al. (2016). Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience. Marmara Medical Journal, 29(2), 79-83. https://doi.org/10.5472/MMJoa.2902.03
AMA Yardımcı S, Kara YB, Attaallah W, Uğurlu MÜ, Yeğen ŞC. Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience. Marmara Med J. April 2016;29(2):79-83. doi:10.5472/MMJoa.2902.03
Chicago Yardımcı, Samet, Yalçın Burak Kara, Wafi Attaallah, Mustafa Ümit Uğurlu, and Şevket Cumhur Yeğen. “Seton Drainage Combined With Anti-Tnf Therapy for Perianal Fistulizing Crohn’s Disease, Single Center Experience”. Marmara Medical Journal 29, no. 2 (April 2016): 79-83. https://doi.org/10.5472/MMJoa.2902.03.
EndNote Yardımcı S, Kara YB, Attaallah W, Uğurlu MÜ, Yeğen ŞC (April 1, 2016) Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience. Marmara Medical Journal 29 2 79–83.
IEEE S. Yardımcı, Y. B. Kara, W. Attaallah, M. Ü. Uğurlu, and Ş. C. Yeğen, “Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience”, Marmara Med J, vol. 29, no. 2, pp. 79–83, 2016, doi: 10.5472/MMJoa.2902.03.
ISNAD Yardımcı, Samet et al. “Seton Drainage Combined With Anti-Tnf Therapy for Perianal Fistulizing Crohn’s Disease, Single Center Experience”. Marmara Medical Journal 29/2 (April 2016), 79-83. https://doi.org/10.5472/MMJoa.2902.03.
JAMA Yardımcı S, Kara YB, Attaallah W, Uğurlu MÜ, Yeğen ŞC. Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience. Marmara Med J. 2016;29:79–83.
MLA Yardımcı, Samet et al. “Seton Drainage Combined With Anti-Tnf Therapy for Perianal Fistulizing Crohn’s Disease, Single Center Experience”. Marmara Medical Journal, vol. 29, no. 2, 2016, pp. 79-83, doi:10.5472/MMJoa.2902.03.
Vancouver Yardımcı S, Kara YB, Attaallah W, Uğurlu MÜ, Yeğen ŞC. Seton drainage combined with anti-tnf therapy for perianal fistulizing Crohn’s disease, single center experience. Marmara Med J. 2016;29(2):79-83.