1
|
Herreros MD, Ramirez JM, Otero-Piñeiro AM, Martí-Gallostra M, Badiola I, Enríquez-Navascues JM, Millan M, Barreiro EM, De La Portilla F, Suárez Alecha J, García-Olmo D. Use of Darvadstrocel (Allogenic Stem Cell Therapy) for Crohn's Fistulas in Real Clinical Practice: The National Project to Implement Mesenchymal Stem Cell for the Treatment of Perianal Crohn's Fistula (the PRIME Study). Dis Colon Rectum 2024; 67:960-967. [PMID: 38603800 DOI: 10.1097/dcr.0000000000003216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
BACKGROUND Perianal fistulas may affect 15% to 50% of patients with Crohn's disease. Treatment is complex, requiring a multidisciplinary approach. Darvadstrocel (allogenic mesenchymal cells obtained from lipoaspirates) was approved in 2018 by the European and Spanish Agencies of Medicines and Medical Products as a treatment for fistulas in Crohn's disease. Recent guidelines from the European Crohn's and Colitis Organisation and Spanish Working Group on Crohn's Disease and Ulcerative Colitis state that darvadstrocel is effective with a favorable safety profile and a strong level of evidence (n = 2). OBJECTIVE Presenting real-world effectiveness data for darvadstrocel in a Spanish population. DESIGN Observational retrospective cohort study with prospective data gathering. SETTINGS The study was conducted at 14 institutions in Spain. PATIENTS From November 2019 to April 2022, all patients (n = 73) treated with darvadstrocel in these institutions were included, fulfilling the following criteria: 1) complex fistula/s in a patient with Crohn's disease; 2) failure of conventional and antitumor necrosis factor treatment; and 3) the absence of collections of >2 cm confirmed by pelvic MRI at the time of surgery. INTERVENTIONS Darvadstrocel treatment. MAIN OUTCOME MEASURES Clinical response (closure of 50% or more of external openings), complete clinical closure (100% of external openings), and radiological closure (no fluid collection >2 cm, edema, or inflammation) evaluated 6 months after treatment. RESULTS Clinical response was observed in 63 patients (86.3%), complete clinical closure in 50 patients (68.5%), and radiological closure in 45 patients (69.2%). Combined clinical and radiological response was observed in 41 patients (63.1%). Not all clinically healed patients had radiological closure, and vice versa. No serious adverse events were reported. LIMITATIONS Retrospective nature of the study. CONCLUSIONS Study results were consistent with those reported in previous clinical trials, real-world efficacy findings from the INSPIRE study (assessing darvadstrocel effectiveness in Europe, Israel, Switzerland, United Kingdom, and Japan), and previously published literature. Darvadstrocel was effective and demonstrated a favorable safety profile when used in normal clinical practice for the treatment of fistulas in Crohn's disease. See Video Abstract . USO DE DARVADSTROCEL TERAPIA CON CLULAS MADRE ALOGNICAS PARA FSTULA EN ENFERMEDAD DE CROHN EN LA PRCTICA CLNICA REAL EL PROYECTO NACIONAL PARA IMPLEMENTAR DE CLULAS MADRE MESENQUIMALES PARA EL TRATAMIENTO DE LA FSTULA DE CROHN PERIANAL EL ESTUDIO PRIME ANTECEDENTES:Las fístulas perianales pueden afectar entre el 15 y el 50% de los pacientes con enfermedad de Crohn. El tratamiento es complejo y requiere un enfoque multidisciplinario. El darvadstrocel (células mesenquimales alogénicas obtenidas a partir de lipoaspirados) fue aprobado en 2018 por las Agencias Europea y Española de Medicamentos y Productos Sanitarios como tratamiento de las fístulas en la EC. Las recientes directrices de la Organización Europea de Crohn y Colitis y del Grupo de Trabajo Español sobre la Enfermedad de Crohn y Colitis Ulcerosa afirman que darvadstrocel es eficaz con un perfil de seguridad favorable y un sólido nivel de evidencia (2).OBJETIVO:Presentar datos de eficacia real de darvadstrocel en población española.DISEÑO:Estudio de cohorte retrospectivo observacional con recopilación prospectiva de datos.ESCENARIO:14 instituciones.PACIENTES:Desde noviembre de 2019 hasta abril de 2022, se incluyeron todos los pacientes (73) tratados con darvadstrocel en estas instituciones, que cumplieron los siguientes criterios: 1) fístula/s compleja/s en un paciente con enfermedad de Crohn; 2) fracaso del tratamiento convencional y anti factor de necrosis tumoral; 3) ausencia de colecciones > 2 cm confirmada por resonancia magnética pélvica en el momento de la cirugía.INTERVENCIONES:Tratamiento con Darvadstrocel.PRINCIPALES MEDIDAS DE RESULTADO:Respuesta clínica (cierre de ≥50% de las aberturas externas), cierre clínico completo (100% de las aberturas externas) y cierre radiológico (sin acumulación de líquido >2 cm, sin edema ni inflamación) evaluados 6 meses después del tratamiento.RESULTADOS:Se observó respuesta clínica en 63 pacientes (86.3%), cierre clínico completo en 50 pacientes (68.5%) y cierre radiológico en 45 pacientes (69.2%). Se observó respuesta clínica y radiológica combinada en 41 pacientes (63.1%). No todos los pacientes clínicamente curados tuvieron cierre radiológico y viceversa. No hubo eventos adversos graves reportados.LIMITACIONES:Estudio retrospectivoCONCLUSIONES:Los resultados del estudio fueron consistentes con los informados en ensayos clínicos anteriores, los hallazgos de eficacia en el mundo real del estudio INSPIRE (que evalúa la efectividad de darvadstrocel en Europa, Israel, Suiza, el Reino Unido y Japón) y la literatura publicada anteriormente. Darvadstrocel fue eficaz y demostró un perfil de seguridad favorable cuando se utiliza en la práctica clínica habitual para el tratamiento de fístulas en la enfermedad de Crohn. (Traducción-Dr. Jorge Silva Velazco ).
Collapse
Affiliation(s)
- Maria Dolores Herreros
- Department of Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
- New Therapy Laboratory, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - Jose-Manuel Ramirez
- Department of Surgery, University of Zaragoza, Zaragoza, Spain
- Spanish Multimodal Rehabilitation Group (GERM), Zaragoza, Spain
| | | | | | - Izaskun Badiola
- Department of Surgery University Hospital Galdakao-Usansolo, Vizcaya, Pais Vasco, Spain
| | | | - Monica Millan
- Department of Surgery, University Hospital la Fe, Valencia, Spain
| | - Erica M Barreiro
- Department of Surgery, University Hospital of Pontevedra, Galicia, Spain
| | | | | | - Damian García-Olmo
- Department of Surgery, University Hospital Fundación Jiménez Díaz, Madrid, Spain
- New Therapy Laboratory, Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
- Surgery Department, Universidad Autonoma de Madrid, Madrid, Spain
| |
Collapse
|
2
|
Yamamoto T, Nakase H, Watanabe K, Shinzaki S, Takatsu N, Fujii T, Okamoto R, Matsuoka K, Yamada A, Kunisaki R, Matsuura M, Shiga H, Bamba S, Mikami Y, Shimoyama T, Motoya S, Torisu T, Kobayashi T, Ohmiya N, Saruta M, Matsuda K, Matsumoto T, Maemoto A, Murata Y, Yoshigoe S, Nagasaka S, Yajima T, Hisamatsu T. Diagnosis and Clinical Features of Perianal Lesions in Newly Diagnosed Crohn's Disease: Subgroup Analysis from Inception Cohort Registry Study of Patients with Crohn's Disease (iCREST-CD). J Crohns Colitis 2023; 17:1193-1206. [PMID: 36869815 PMCID: PMC10441562 DOI: 10.1093/ecco-jcc/jjad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND AND AIMS Perianal lesion is a refractory phenotype of Crohn's disease [CD] with significantly diminished quality of life. We evaluated the clinical characteristics of perianal lesions in newly diagnosed CD patients and the impact of perianal lesions on the quality of life in Japanese patients with CD. METHODS Patients newly diagnosed with CD after June 2016 were included between December 2018 and June 2020 from the Inception Cohort Registry Study of Patients with CD [iCREST-CD]. RESULTS Perianal lesions were present in 324 [48.2%] of 672 patients with newly diagnosed CD; 71.9% [233/324] were male. The prevalence of perianal lesions was higher in patients aged <40 years vs ≥40 years, and it decreased with age. Perianal fistula [59.9%] and abscess [30.6%] were the most common perianal lesions. In multivariate analyses, male sex, age <40 years and ileocolonic disease location were significantly associated with a high prevalence of perianal lesions, whereas stricturing behaviour and alcohol intake were associated with low prevalence. Fatigue was more frequent [33.3% vs 21.6%] while work productivity and activity impairment-work time missed [36.3% vs 29.5%] and activity impairment [51.9% vs 41.1%] were numerically higher in patients with than those without perianal lesions. CONCLUSIONS At the time of CD diagnosis, approximately half of the patients had perianal lesions; perianal abscesses and perianal fistulas were the most common. Young age, male sex, disease location and behaviour were significantly associated with the presence of perianal lesions. The presence of perianal lesion was associated with fatigue and impairment of daily activities. CLINICAL TRIALS REGISTRY University Hospital Medical Information Network Clinical Trials Registry System [UMIN-CTR, UMIN000032237].
Collapse
Affiliation(s)
- Takayuki Yamamoto
- Department of Surgery and Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyama-cho Yokkaichi, Mie, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, 16-291 South-1 jo-nishi, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Kenji Watanabe
- Centre for Inflammatory Bowel Disease, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Shinichiro Shinzaki
- Centre for Inflammatory Bowel Disease, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo Medical University, Nishinomiya, Hyogo, Japan
- Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Noritaka Takatsu
- Department of Inflammatory Bowel Disease Centre, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin Chikushino, Fukuoka, Japan
| | - Toshimitsu Fujii
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Ryuichi Okamoto
- Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Katsuyoshi Matsuoka
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, 564-1 Shimoshizu, Sakura, Chiba, Japan
| | - Akihiro Yamada
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Sakura Medical Centre, 564-1 Shimoshizu, Sakura, Chiba, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Centre, Yokohama City University Medical Centre, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, Japan
| | - Minoru Matsuura
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Tokyo, Japan
| | - Hisashi Shiga
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seyro-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Shigeki Bamba
- Division of Digestive Endoscopy, Shiga University of Medical Science, Seta Tsukinowa-cho, Otsu, Shiga, Japan
| | - Yohei Mikami
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University, 35 Shinanomachi, Shinjiku-ku, Tokyo, Japan
| | - Takahiro Shimoyama
- Department of Surgery and Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, 10-8 Hazuyama-cho Yokkaichi, Mie, Japan
| | - Satoshi Motoya
- IBD Centre, Hokkaido Preventive Welfare Federation of Agricultural Cooperative, Sapporo-Kosei General Hospital, 8-5 Kita-3 johigashi, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Takehiro Torisu
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1, Maidashi, Higashi-ku, Fukuoka, Fukuoka, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, 5-9-1, Shirokane, Minato-ku, Tokyo, Japan
| | - Naoki Ohmiya
- Department of Advanced Endoscopy, Fujita Health University School of Medicine, 1-98 Dengakukubo, Kutsukake-Cho, Toyoake, Aichi, Japan
| | - Masayuki Saruta
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishi-shinbashi, Minato-ku, Tokyo, Japan
| | - Koichiro Matsuda
- Department of Gastroenterology, Toyama Preventive Central Hospital, 2 -2 -78, Nishinagae, Toyama, Japan
| | - Takayuki Matsumoto
- Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, 10-1, Uchimaru, Morioka, Iwate, Japan
| | - Atsuo Maemoto
- IBD Centre, Sapporo Higashi Tokushima Hospital, 3-1, Kita 33 Higashi 14, Higashiku, Sapporo, Hokkaido, Japan
| | - Yoko Murata
- Immunology, Medical Affairs Division, Janssen Pharmaceuticals K.K., 3-5-2 Nishi-Kanda, Chiyoda-ku, Tokyo, Japan
| | - Shinichi Yoshigoe
- Immunology, Medical Affairs Division, Janssen Pharmaceuticals K.K., 3-5-2 Nishi-Kanda, Chiyoda-ku, Tokyo, Japan
| | - Shinya Nagasaka
- Immunology, Medical Affairs Division, Janssen Pharmaceuticals K.K., 3-5-2 Nishi-Kanda, Chiyoda-ku, Tokyo, Japan
| | - Tsutomu Yajima
- Statistics and Decision Sciences (SDS), Janssen Pharmaceuticals K.K., 3-5-2 Nishi-Kanda, Chiyoda-ku, Tokyo, Japan
| | - Tadakazu Hisamatsu
- Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Tokyo, Japan
| |
Collapse
|
3
|
Feroz SH, Ahmed A, Muralidharan A, Thirunavukarasu P. Comparison of the Efficacy of the Various Treatment Modalities in the Management of Perianal Crohn's Fistula: A Review. Cureus 2020; 12:e11882. [PMID: 33415035 PMCID: PMC7781784 DOI: 10.7759/cureus.11882] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Crohn's disease (CD) is a transmural inflammatory bowel disease (IBD) that can affect any part of the gastrointestinal (GI) tract. With the disease's progression, adhesions and transmural fissuring, intra-abdominal abscesses, and fistula tracts may develop. An anal fistula (or fistula-in-ano) is a chronic abnormal epithelial lined tract communicating the anorectal lumen (internal opening) to the perineal or buttock skin (external opening). The risk of fistula development varies from 14%-38%. It can cause significant morbidity, which adversely impacts the quality of life. It is mostly believed that an anal crypt gland infection causes anal abscesses, leading to fistula development. Crohn's disease's pathogenesis involves Th1 and Th17 hypersensitivity due to an unknown antigen within the intestinal mucosa. Evidence to support this review was gathered via the Pubmed database. Search terms used were combinations of "Perianal fistula," "seton," "immunotherapy." Studies were reviewed and cross‐referenced for additional reports. Setons are surgical thread loops passed from the external to the internal opening of the fistula tract and exteriorized through the anorectal canal, facilitating abscess drainage and inciting a local inflammatory reaction, thus promoting the resolution of the fistula. Biologicals such as anti-tumor necrosis factor (TNF) antibody (infliximab, adalimumab, certolizumab), anti-IL-12/23 (ustekinumab), and anti-α₄β₇ integrin antibody (vedolizumab) have been approved for Crohn's disease targeting the Th1/Th17-mediated inflammation. Other therapeutic modalities are fistulotomy, cyanoacrylate glue, bioprosthetic plugs, mucosal advancement flap, ligation of inter-sphincteric fistula tract (LIFT), diverting stoma, proctectomy, video-assisted anal fistula treatment (VAAFT), and fistula laser closure (FiLaC). Our review found that chronic seton therapy should be the primary approach, especially if the patient has a perianal abscess. It has a low incidence of re-intervention, recurrent abscess formation, and side-branching of the fistulous tract, with preservation of the fistulous tract's patency and cost-effectiveness. The major disadvantage of seton therapy is the discomfort and time to achieve stability. Among the biologicals, infliximab is the only therapy which has a statistically significant effect on the healing rate of perianal Crohn's fistula compared to placebo, but the major disadvantage associated with anti-TNF as sole therapy is high re-intervention rate, prolong maintenance therapy, high recurrence rate, and severe side effects. We hypothesize that the two aspects should be addressed concurrently to increase the fistula healing or closure rate. First, the seton should be used as initial therapy to maintain tract patency to allow abscess drainage and minimize the intestinal flora colonization within the tract mucosa, thereby leukocytic infiltration and propagation of inflammation within the tract. The second aspect that has to be considered is that we should target the initial stimulation of the Th1/Th17 mediated hypersensitivity instead of a factor/cytokine involved in the inflammation mediation. Although the unknown antigen triggering such hypersensitivity is not clear, we could target the RAR-related orphan receptor γ (RORγ)-T (transcription factor involved in activation of Th17 cells) and the T-bet (transcription factor involved in activation of Th17 cells) within the GI mucosa by a novel target immune therapy.
Collapse
Affiliation(s)
- Shah Huzaifa Feroz
- General Surgery, Jawaharlal Nehru Medical College, Aligarh, IND.,General Surgery, Larkin Community Hospital, Miami, USA
| | - Asma Ahmed
- General Surgery, Ramaiah Medical College and Hospital, Bangalore, IND
| | | | | |
Collapse
|
4
|
Knotless seton for perianal fistulas: feasibility and effect on perianal disease activity. Sci Rep 2020; 10:16693. [PMID: 33028875 PMCID: PMC7541651 DOI: 10.1038/s41598-020-73737-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023] Open
Abstract
Patients with perianal fistulas are frequently treated by a knotted seton which is well-known for causing complaints. We aimed to assess the feasibility of the knotless SuperSeton and advantages with respect to perianal disease activity. In a prospective cohort study, we included all consecutive adult patients with a knotted seton in situ or a perianal fistula requiring new seton drainage. Primary endpoint was seton feasibility (maintenance of the connection for minimally three months). Secondary endpoints included improvement of the Perianal Disease Activity Index (PDAI), complications and re-interventions within three months of follow-up. PDAI scores of patients with a knotted seton were crossover compared to PDAI scores after knotless seton replacement. Sixty patients (42% male, mean age 42 (SD 13.15), 41 with Crohn’s disease) were included between August 2016 and April 2018. Of 79 knotless setons, 69 (87.3%) stayed connected for ≥ 3 months. Overall, the knotless seton significantly decreased discharge (P = 0.001), pain (P < 0.001) and induration (P < 0.001) measured by the PDAI when compared to baseline. In patients with a knotted seton, replacement by the knotless seton significantly decreased discharge (P = 0.005) and pain (P < 0.001) measured by the PDAI. Furthermore, 71% of patients reported fewer cleaning problems compared to the knotted seton. Ten patients developed a perianal abscess, and five patients required a re-intervention. This study supports the feasibility of the knotless seton with promising short-term results. The knotless seton might be preferred over the knotted seton in terms of perianal disease activity.
Collapse
|
5
|
Wasmann KA, de Groof EJ, Stellingwerf ME, D’Haens GR, Ponsioen CY, Gecse KB, Dijkgraaf MGW, Gerhards MF, Jansen JM, Pronk A, van Tuyl SAC, Zimmerman DDE, Bruin KF, Spinelli A, Danese S, van der Bilt JDW, Mundt MW, Bemelman WA, Buskens CJ. Treatment of Perianal Fistulas in Crohn's Disease, Seton Versus Anti-TNF Versus Surgical Closure Following Anti-TNF [PISA]: A Randomised Controlled Trial. J Crohns Colitis 2020; 14:1049-1056. [PMID: 31919501 PMCID: PMC7476637 DOI: 10.1093/ecco-jcc/jjaa004] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Most patients with perianal Crohn's fistula receive medical treatment with anti-tumour necrosis factor [TNF], but the results of anti-TNF treatment have not been directly compared with chronic seton drainage or surgical closure. The aim of this study was to assess if chronic seton drainage for patients with perianal Crohn's disease fistulas would result in less re-interventions, compared with anti-TNF and compared with surgical closure. METHODS This randomised trial was performed in 19 European centres. Patients with high perianal Crohn's fistulas with a single internal opening were randomly assigned to: i] chronic seton drainage for 1 year; ii] anti-TNF therapy for 1 year; and iii] surgical closure after 2 months under a short course anti-TNF. The primary outcome was the cumulative number of patients with fistula-related re-intervention[s] at 1.5 years. Patients declining randomisation due to a specific treatment preference were included in a parallel prospective PISA registry cohort. RESULTS Between September 14, 2013 and November 20, 2017, 44 of the 126 planned patients were randomised. The study was stopped by the data safety monitoring board because of futility. Seton treatment was associated with the highest re-intervention rate [10/15, versus 6/15 anti-TNF and 3/14 surgical closure patients, p = 0.02]. No substantial differences in perianal disease activity and quality of life between the three treatment groups were observed. Interestingly, in the PISA prospective registry, inferiority of chronic seton treatment was not observed for any outcome measure. CONCLUSIONS The results imply that chronic seton treatment should not be recommended as the sole treatment for perianal Crohn's fistulas.
Collapse
Affiliation(s)
- Karin A Wasmann
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands,Corresponding author: Dr Christianne J. Buskens, MD PhD, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | | | | | - Geert R D’Haens
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Krisztina B Gecse
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis, Utrecht, The Netherlands
| | | | - David D E Zimmerman
- Department of Surgery, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Karlien F Bruin
- Department of Gastroenterology and Hepatology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Antonino Spinelli
- Department of Surgery, Humanitas Research Hospital and Humanitas University, Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology, Humanitas Research Hospital and Humanitas University, Milan, Italy
| | | | - Marco W Mundt
- Department of Gastroenterology and Hepatology, Flevoziekenhuis, Almere, The Netherlands
| | | | - Christianne J Buskens
- Department of Surgery, Amsterdam UMC, Amsterdam, The Netherlands,Corresponding author: Dr Christianne J. Buskens, MD PhD, Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| |
Collapse
|
6
|
Nuernberg D, Saftoiu A, Barreiros AP, Burmester E, Ivan ET, Clevert DA, Dietrich CF, Gilja OH, Lorentzen T, Maconi G, Mihmanli I, Nolsoe CP, Pfeffer F, Rafaelsen SR, Sparchez Z, Vilmann P, Waage JER. EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound. Ultrasound Int Open 2019; 5:E34-E51. [PMID: 30729231 PMCID: PMC6363590 DOI: 10.1055/a-0825-6708] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 11/23/2018] [Accepted: 12/01/2018] [Indexed: 02/07/2023] Open
Abstract
This article represents part 3 of the EFSUMB Recommendations and Guidelines for Gastrointestinal Ultrasound (GIUS). It provides an overview of the examination techniques recommended by experts in the field of endorectal/endoanal ultrasound (ERUS/EAUS), as well as perineal ultrasound (PNUS). The most important indications are rectal tumors and inflammatory diseases like fistula and abscesses in patients with or without inflammatory bowel disease (IBD). PNUS sometimes is more flexible and convenient compared to ERUS. However, the technique of ERUS is quite well established, especially for the staging of rectal cancer. EAUS also gained ground in the evaluation of perianal diseases like fistulas, abscesses and incontinence. For the staging of perirectal tumors, the use of PNUS in addition to conventional ERUS could be recommended. For the staging of anal carcinomas, PNUS can be a good option because of the higher resolution. Both ERUS and PNUS are considered excellent guidance methods for invasive interventions, such as the drainage of fluids or targeted biopsy of tissue lesions. For abscess detection and evaluation, contrast-enhanced ultrasound (CEUS) also helps in therapy planning.
Collapse
Affiliation(s)
- Dieter Nuernberg
- Medical School Brandenburg Theodor Fontane, Gastroenterology, Neuruppin, Germany
| | - Adrian Saftoiu
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Ana Paula Barreiros
- Deutsche Stiftung Organtransplantation, Head of Organisation Center Middle, Frankfurt, Germany
| | - Eike Burmester
- Department of Internal Medicine/Gastroenterology, Sana-Kliniken Lübeck, Lübeck, Germany
| | - Elena Tatiana Ivan
- Research Center in Gastroenterology and Hepatology, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Dirk-André Clevert
- Department of Clinical Radiology, Interdisciplinary Ultrasound-Center, University of Munich-Grosshadern Campus, Munich, Germany
| | | | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Torben Lorentzen
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L.Sacco" University Hospital, Milan, Italy
| | - Ismail Mihmanli
- Istanbul University - Cerrahpasa, Cerrahpasa Medical Faculty, Department of Radiology and ALKA Radyoloji Tani Merkezi, Istanbul, Turkey
| | - Christian Pallson Nolsoe
- Ultrasound Section, Division of Surgery, Department of Gastroenterology, Herlev Hospital and Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Denmark
| | - Frank Pfeffer
- Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Søren Rafael Rafaelsen
- Colorectal Centre of Excellence, Clinical Cancer Centre, University Hospital of Southern Denmark, Vejle, Denmark
| | - Zeno Sparchez
- 3rd Medical Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Peter Vilmann
- Endoscopy Department, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jo Erling Riise Waage
- Department of Surgery, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
7
|
de Groof EJ, Buskens CJ, Bemelman WA. Single-Port Surgery in Inflammatory Bowel Disease: A Review of Current Evidence. World J Surg 2017; 40:2276-82. [PMID: 27094562 PMCID: PMC4982875 DOI: 10.1007/s00268-016-3509-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The majority of patients with Crohn’s disease and up to 35 % of patients with ulcerative colitis will ultimately require surgery during the course of their disease. Over the past few years, surgical techniques and experience in minimal invasive
surgery have evolved resulting in single-incision laparoscopic surgery. The aim of this approach is to diminish the surgical trauma by reducing the number of incision sites. This review discusses the benefits and disadvantages of single-port surgery in various procedures in patients with inflammatory bowel disease (IBD). Short-term postoperative results, functional outcome, and costs available in the literature will be discussed. Single-port surgery in IBD has several benefits when compared to multi-port laparoscopic surgery. By using fewer incisions, a potential reduction of postoperative pain with less morphine use can be accomplished. In addition, accelerated postoperative recovery can result in a shorter hospital stay. Furthermore, a superior cosmesis can be reached with placement of the port at the future ostomy site or at the umbilicus. Literature on single-port surgery in IBD consists mainly of case series and a few matched case series. These studies demonstrated that single-port surgery seems to be a safe and feasible approach for the surgical treatment of IBD patients.
Collapse
Affiliation(s)
- E Joline de Groof
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Christianne J Buskens
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| |
Collapse
|
8
|
de Groof EJ, Sahami S, Lucas C, Ponsioen CY, Bemelman WA, Buskens CJ. Treatment of perianal fistula in Crohn's disease: a systematic review and meta-analysis comparing seton drainage and anti-tumour necrosis factor treatment. Colorectal Dis 2016; 18:667-75. [PMID: 26921847 DOI: 10.1111/codi.13311] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/18/2015] [Indexed: 12/13/2022]
Abstract
AIM The introduction of anti-tumour necrosis factor (anti-TNF; infliximab and adalimumab) has changed the management of Crohn's perianal fistula from almost exclusively surgical treatment to one with a much larger emphasis on medical therapy. The aim of this systematic review was to provide an overview of the success rates of setons and anti-TNF for Crohn's perianal fistula. METHOD Studies evaluating the effect of setons and anti-TNF on Crohn's perianal fistula were included. Studies assessing perianal fistula in children, rectovaginal and rectourinary fistulae were excluded. The primary end-point was the fistula closure rate. Partial closure and recurrence rates were secondary end-points. RESULTS Ten studies on seton drainage were included (n = 305). Complete closure varied from 13.6% to 100% and recurrence from 0% to 83.3%. In 34 anti-TNF studies (n = 1449), complete closure varied from 16.7% and 93% (partial closure 8.0-91.2%) and recurrence from 8.0% to 40.9%. Four randomized controlled trials (n = 1028) comparing anti-TNF with placebo showed no significant difference in complete or partial closure in meta-analysis (risk difference 0.12, 95% CI -0.06 to 0.30 and 0.09, 95% CI -0.23 to 0.41, respectively). Subgroup analysis (n = 241) showed a significant advantage for complete fistula closure with anti-TNF in two trials with follow-up > 4 weeks (46% vs 13%, P = 0.003 and 30% vs 13%, P = 0.03). Of four included cohort studies, two revealed a significant difference in response in favour of combined treatment (P = 0.001 and P = 0.014). CONCLUSION Closure and recurrence rates after seton drainage as well as anti-TNF vary widely. Despite a large number of studies, no conclusions can be drawn regarding the preferred strategy. However, combination therapy with (temporary) seton drainage, immunomodulators and anti-TNF may be beneficial in achieving perianal fistula closure.
Collapse
Affiliation(s)
- E J de Groof
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - S Sahami
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - C Lucas
- Department of Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
| | - C Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands
| | - W A Bemelman
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - C J Buskens
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
9
|
Prevalence and recurrence rate of perianal abscess--a population-based study, Sweden 1997-2009. Int J Colorectal Dis 2016; 31:669-73. [PMID: 26768004 DOI: 10.1007/s00384-015-2500-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2015] [Indexed: 02/04/2023]
Abstract
INTRODUCTION The aim of this study was to assess the impact of diabetes mellitus, Crohn's disease, HIV/aids, and obesity on the prevalence and readmission rate of perianal abscess. METHODS The study cohort was based on the Swedish National Patient Register and included all patients treated for perianal abscess in Sweden 1997-2009. The prevalence and risk for readmission were assessed in association with four comorbidity diagnoses: diabetes mellitus, Crohn's disease, HIV, and/or AIDS and obesity. RESULTS A total of 18,877 patients were admitted during the study period including 11,138 men and 4557 women (2.4:1). Crohn's disease, diabetes, and obesity were associated with a significantly higher prevalence of perianal abscess than an age- and gender-matched background population (p < 0.05). In univariate analysis, neither age nor gender had any significant impact on the risk for readmission. In a multivariate Cox proportional hazard analysis, Crohns disease was the only significant risk factor for readmission of perianal abscess. CONCLUSION Crohn's disease, diabetes, and obesity increase the risk for perianal abscess. Of these, Crohn's and HIV has an impact on readmission. The pathogenesis and the influence of diabetes and obesity need further research if we are to understand why these diseases increase the risk for perianal abscess but not its recurrence.
Collapse
|
10
|
de Groof EJ, Buskens CJ, Ponsioen CY, Dijkgraaf MGW, D'Haens GRAM, Srivastava N, van Acker GJD, Jansen JM, Gerhards MF, Dijkstra G, Lange JFM, Witteman BJM, Kruyt PM, Pronk A, van Tuyl SAC, Bodelier A, Crolla RMPH, West RL, Vrijland WW, Consten ECJ, Brink MA, Tuynman JB, de Boer NKH, Breukink SO, Pierik MJ, Oldenburg B, van der Meulen AE, Bonsing BA, Spinelli A, Danese S, Sacchi M, Warusavitarne J, Hart A, Yassin NA, Kennelly RP, Cullen GJ, Winter DC, Hawthorne AB, Torkington J, Bemelman WA. Multimodal treatment of perianal fistulas in Crohn's disease: seton versus anti-TNF versus advancement plasty (PISA): study protocol for a randomized controlled trial. Trials 2015; 16:366. [PMID: 26289163 PMCID: PMC4545975 DOI: 10.1186/s13063-015-0831-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 06/30/2015] [Indexed: 02/06/2023] Open
Abstract
Background Currently there is no guideline for the treatment of patients with Crohn’s disease and high perianal fistulas. Most patients receive anti-TNF medication, but no long-term results of this expensive medication have been described, nor has its efficiency been compared to surgical strategies. With this study, we hope to provide treatment consensus for daily clinical practice with reduction in costs. Methods/Design This is a multicentre, randomized controlled trial. Patients with Crohn’s disease who are over 18 years of age, with newly diagnosed or recurrent active high perianal fistulas, with one internal opening and no anti-TNF usage in the past three months will be considered. Patients with proctitis, recto-vaginal fistulas or anal stenosis will be excluded. Prior to randomisation, an MRI and ileocolonoscopy are required. All treatment will start with seton placement and a course of antibiotics. Patients will then be randomised to: (1) chronic seton drainage (with oral 6-mercaptopurine (6MP)) for one year, (2) anti-TNF medication (with 6MP) for one year (seton removal after six weeks) or (3) advancement plasty after eight weeks of seton drainage (under four months anti-TNF and 6MP for one year). The primary outcome parameter is the number of patients needing fistula-related re-intervention(s). Secondary outcomes are the number of patients with closed fistulas (based on an evaluated MRI score) after 18 months, disease activity, quality of life and costs. Discussion The PISA trial is a multicentre, randomised controlled trial of patients with Crohn’s disease and high perianal fistulas. With the comparison of three generally accepted treatment strategies, we will be able to comment on the efficiency of the various treatment strategies, with respect to several long-term outcome parameters. Trial registration Nederlands Trial Register identifier: NTR4137 (registered on 23 August 2013). Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0831-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- E Joline de Groof
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands. .,Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Christianne J Buskens
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands.
| | - Cyriel Y Ponsioen
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Marcel G W Dijkgraaf
- Clinical Research Unit, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Geert R A M D'Haens
- Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Nidhi Srivastava
- Department of Gastroenterology and Hepatology, Medical Center Haaglanden, Lijnbaan 32, 2512 VA Den Haag, The Netherlands.
| | - Gijs J D van Acker
- Department of Surgery, Medical Center Haaglanden, Lijnbaan 32, 2512 VA Den Haag, The Netherlands.
| | - Jeroen M Jansen
- Department of Gastroenterology and Hepatology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
| | - Michael F Gerhards
- Department of Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.
| | - Gerard Dijkstra
- Department of Gastroenterology and Hepatology, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Johan F M Lange
- Department of Surgery, University Medical Center Groningen, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
| | - Ben J M Witteman
- Department of Gastroenterology and Hepatology, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - Philip M Kruyt
- Department of Surgery, Hospital Gelderse Vallei, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands.
| | - Apollo Pronk
- Department of Surgery, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
| | - Sebastiaan A C van Tuyl
- Department of Gastroenterology and Hepatology, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE Utrecht, The Netherlands.
| | - Alexander Bodelier
- Department of Gastroenterology and Hepatology, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands.
| | - Rogier M P H Crolla
- Department of Surgery, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Rachel L West
- Department of Gastroenterology and Hepatology, St Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
| | - Wietske W Vrijland
- Department of Surgery, St Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands.
| | - Esther C J Consten
- Department of Surgery, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands.
| | - Menno A Brink
- Department of Gastroenterology and Hepatology, Meander Medical Center, Maatweg 3, 3813 TZ Amersfoort, The Netherlands.
| | - Jurriaan B Tuynman
- Department of Surgery, VU Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
| | - Nanne K H de Boer
- Department of Gastroenterology and Hepatology, VU Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands.
| | - Stephanie O Breukink
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
| | - Marieke J Pierik
- Department of Gastroenterology and Hepatology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
| | - Bas Oldenburg
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
| | - Andrea E van der Meulen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Antonino Spinelli
- Department of Surgery, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy.
| | - Silvio Danese
- Department of Gastroenterology and Hepatology, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy.
| | - Matteo Sacchi
- Department of Surgery, Humanitas Hospital, Via Alessandro Manzoni, 56, 20089 Rozzano MI, Milan, Italy.
| | - Janindra Warusavitarne
- Department of Surgery, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, UK.
| | - Ailsa Hart
- Department of Gastroenterology and Hepatology, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, England.
| | - Nuha A Yassin
- Department of Surgery, St Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, London, UK.
| | - Rory P Kennelly
- Department of Surgery, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - Garret J Cullen
- Department of Gastroenterology and Hepatology, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - Desmond C Winter
- Department of Surgery, St Vincent's Healthcare Group, Elm Park, Merrion Rd, Dublin 4, Ireland.
| | - A Barney Hawthorne
- Department of Gastroenterology and Hepatology, Spire Cardiff Hospital, Glamorgan House, Croescadarn Rd, Cardiff, South Glamorgan CF23 8XL, UK.
| | - Jared Torkington
- Department of Surgery, Spire Cardiff Hospital, Glamorgan House, Croescadarn Rd, Cardiff, South Glamorgan CF23 8XL, England.
| | - Willem A Bemelman
- Department of Surgery, Academic Medical Center, PO Box 22660, 1100, DD, Amsterdam, The Netherlands.
| |
Collapse
|
11
|
Wang YG, Ding JH, Zhao K. Methods for preoperative assessment of anal fistula. Shijie Huaren Xiaohua Zazhi 2014; 22:2265-2270. [DOI: 10.11569/wcjd.v22.i16.2265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Anal fistula is one of the most common perianal diseases, and methods for its preoperative assessment are diverse. Traditional methods include physical examination, probing, Goodsall's law, methylene blue test, and so on. Although traditional methods play a role, their accuracy for complex anal fistulas is low. Therefore, their application must be combined with other methods. Fistulography fails to depict the relationship of the fistula to the sphincter complex, and computed tomography lacks specificity to distinguish between fistula and surrounding muscle tissue. Both methods are rarely used now. Magnetic resonance imaging and three-dimensional anorectal endosonography have become routine preoperative examinations and play an important role for guiding precise surgery. However, they also have their own shortcomings. In this paper, we will summarize a variety of methods for preoperative assessment of anal fistula.
Collapse
|
12
|
Optimising monitoring in the management of Crohn's disease: a physician's perspective. J Crohns Colitis 2013; 7:653-69. [PMID: 23562672 DOI: 10.1016/j.crohns.2013.02.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 02/05/2013] [Indexed: 02/08/2023]
Abstract
Management of Crohn's disease has traditionally placed high value on subjective symptom assessment; however, it is increasingly appreciated that patient symptoms and objective parameters of inflammation can be disconnected. Therefore, strategies that objectively monitor inflammatory activity should be utilised throughout the disease course to optimise patient management. Initially, a thorough assessment of the severity, location and extent of disease is needed to ensure a correct diagnosis, identify any complications, help assess prognosis and select appropriate therapy. During follow-up, clinical decision-making should be driven by disease activity monitoring, with the aim of optimising treatment for tight disease control. However, few data exist to guide the choice of monitoring tools and the frequency of their use. Furthermore, adaption of monitoring strategies for symptomatic, asymptomatic and post-operative patients has not been well defined. The Annual excHangE on the ADvances in Inflammatory Bowel Disease (IBD Ahead) 2011 educational programme, which included approximately 600 gastroenterologists from 36 countries, has developed practice recommendations for the optimal monitoring of Crohn's disease based on evidence and/or expert opinion. These recommendations address the need to incorporate different modalities of disease assessment (symptom and endoscopic assessment, measurement of biomarkers of inflammatory activity and cross-sectional imaging) into robust monitoring. Furthermore, the importance of measuring and recording parameters in a standardised fashion to enable longitudinal evaluation of disease activity is highlighted.
Collapse
|
13
|
Novak KL, Wilson SR. Sonography for surveillance of patients with Crohn disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:1147-1152. [PMID: 22837277 DOI: 10.7863/jum.2012.31.8.1147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Kerri L Novak
- Department of Medicine, Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
| | | |
Collapse
|