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Schroeder MK, Abushamma S, George AT, Ravella B, Hickman J, Elumalai A, Wise P, Zulfiqar M, Ludwig DR, Shetty A, Viswanath SE, Luo C, Sebastian S, Ballard DH, Deepak P. TOpCLASS Expert Consensus Classification of Perianal Fistulising Crohn's Disease: A Real-world Application in a Serial Fistula MRI Cohort. J Crohns Colitis 2024; 18:1430-1439. [PMID: 38642332 DOI: 10.1093/ecco-jcc/jjae056] [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: 01/07/2024] [Revised: 03/09/2024] [Accepted: 04/16/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND AIMS Perianal fistuliing Crohn's disease [PFCD] is an aggressive phenotype of Crohn's disease defined by frequent relapses and disabling symptoms. A novel consensus classification system was recently outlined by the TOpCLASS consortium, which seeks to unify disease severity with patient-centred goals but has not yet been validated. We aimed to apply this to a real-world cohort and to identify factors that predict transition between classes over time. METHODS We identified all patients with PFCD and at least one baseline and one follow-up pelvic MRI [pMRI]. TOpCLASS classification, disease characteristics, and imaging indices were collected retrospectively at time periods corresponding with respective MRIs. RESULTS We identified 100 patients with PFCD, of whom 96 were assigned TOpCLASS Classes 1-2c at baseline. Most patients [78.1%] started in Class 2b, but changes in classification were observed in 52.1% of all patients. Male sex [72.0%, 46.6%, 40.0%, p = 0.03] and prior perianal surgery [52.0% vs 44.6% vs 40.0%, p = 0.02] were more frequently observed in those with improved class compared to unchanged and worsened class. Baseline pMRI indices were not associated with changes in classification; however, greater improvements in mVAI, MODIFI-CD, and PEMPAC were seen among those who improved. Linear mixed effect modelling identified only male sex [-0.31, 95% CI -0.60 to -0.02] with improvement in class. CONCLUSION The TOpCLASS classification highlights the dynamic nature of PFCD over time. However, our ability to predict transitions between classes remains limited and requires prospective assessment. Improvement in MRI index scores over time was associated with a transition to lower TOpCLASS classification.
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Affiliation(s)
- Matthew K Schroeder
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Suha Abushamma
- Division of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Alvin T George
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | | | - John Hickman
- Division of Gastroenterology, University of Virginia, Charlottesville, VA, USA
| | - Anusha Elumalai
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Paul Wise
- Section of Colon and Rectal Surgery, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Maria Zulfiqar
- Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Anup Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | - Satish E Viswanath
- Department of Biomedical Engineering, School of Engineering, Case Western Reserve University, Cleveland, OH, USA
| | - Chongliang Luo
- Division of Public Health Sciences, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
| | | | - David H Ballard
- Division of Gastroenterology, Cleveland Clinic, Cleveland, OH, USA
| | - Parakkal Deepak
- Division of Gastroenterology, Washington University School of Medicine in Saint Louis, St. Louis, MO, USA
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Casanova MJ, Caballol B, García MJ, Mesonero F, Rubín de Célix C, Suárez-Álvarez P, Ferreiro-Iglesias R, Martín-Rodríguez MDM, de Francisco R, Varela-Trastoy P, Bastida G, Carrillo-Palau M, Núñez-Ortiz A, Ramírez-de la Piscina P, Ceballos D, Hervías-Cruz D, Muñoz-Pérez R, Velayos B, Bermejo F, Busquets D, Cabacino M, Camo-Monterde P, Marín-Jiménez I, Muñoz C, de la Peña-Negro LC, Sierra-Moros E, Barrio J, Brunet-Mas E, Bujanda L, Cañete F, Gomollón F, Manceñido-Marcos N, Rodríguez-Lago I, Rodríguez-Grau MC, Sicilia B, Torra-Alsina S, Arranz-Hernández L, Carpio D, García-Sepulcre MF, González-Muñoza C, Huguet JM, Márquez-Mosquera L, López-Serrano MP, Ponferrada-Díaz Á, Chaparro M, Gisbert JP. Persistence, effectiveness and safety of ustekinumab and vedolizumab therapy for complex perianal fistula in Crohn's disease: The HEAL study from GETECCU. Dig Liver Dis 2024:S1590-8658(24)00766-7. [PMID: 38839456 DOI: 10.1016/j.dld.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND The efficacy of ustekinumab and vedolizumab for treating complex perianal fistula in Crohn's disease has been barely studied. We aimed to assess treatment persistence, clinical remission, and safety of these drugs in this context. METHODS Crohn's disease patients who had received ustekinumab or vedolizumab for the indication of active complex perianal fistula, were included. Clinical remission was defined according to Fistula Drainage Assessment Index (no drainage through the fistula upon gentle pressure) based on physicians' assessment. RESULTS Of 155 patients, 136 received ustekinumab, and 35 vedolizumab (16 received both). Median follow-up for ustekinumab was 27 months. Among those on ustekinumab, 54 % achieved remission, and within this group, 27 % relapsed during follow-up. The incidence rate of relapse was 11 % per patient-year. Multivariate analysis found no variables associated with treatment discontinuation or relapse. Median follow-up time for patients receiving vedolizumab was 19 months. Remission was achieved in 46 % of the patients receiving vedolizumab, and among them, 20 % relapsed during follow-up. The incidence rate of relapse was 7 % per patient-year. Adverse events were mild in 6 % on ustekinumab and 8 % on vedolizumab. CONCLUSION Ustekinumab and vedolizumab appear effective, achieving remission in around half of complex perianal fistula patients, with favorable safety profiles.
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Affiliation(s)
- María José Casanova
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.
| | - Berta Caballol
- Department of Gastroenterology, Hospital Clínic i Provincial, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and CIBEREHD, Barcelona, Spain
| | - María José García
- Department of Gastroenterology, Hospital Universitario Marqués de Valdecilla and Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Francisco Mesonero
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Cristina Rubín de Célix
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | | | - Rocío Ferreiro-Iglesias
- Department of Gastroenterology, Hospital Clínico Universitario de Santiago de Compostela and Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | | | - Ruth de Francisco
- Department of Gastroenterology, Hospital Universitario Central de Asturias and Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Pilar Varela-Trastoy
- Department of Gastroenterology, Hospital Universitario de Cabueñes, Gijón, Spain
| | - Guillermo Bastida
- Department of Gastroenterology, Hospital Universitario y Politécnico La Fe, and CIBEREHD, Valencia, Spain
| | - Marta Carrillo-Palau
- Department of Gastroenterology, Hospital Universitario de Canarias, La Laguna, Spain
| | - Andrea Núñez-Ortiz
- Department of Gastroenterology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Daniel Ceballos
- Department of Gastroenterology, Hospital Universitario de Gran Canaria Dr. Negrín, Las Palmas de Gran Canaria, Spain
| | - Daniel Hervías-Cruz
- Department of Gastroenterology, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Roser Muñoz-Pérez
- Department of Gastroenterology, Hospital General Universitario Dr. Balmis, and CIBEREHD, Alicante, Spain
| | - Benito Velayos
- Department of Gastroenterology, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Fernando Bermejo
- Department of Gastroenterology, Hospital Universitario de Fuenlabrada and Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - David Busquets
- Department of Gastroenterology, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - Manuel Cabacino
- Department of Gastroenterology, Hospital General Universitario de Castellón, Castellón, Spain
| | | | - Ignacio Marín-Jiménez
- Department of Gastroenterology, Hospital Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), and Universidad Complutense de Madrid, Madrid, Spain
| | - Carmen Muñoz
- Department of Gastroenterology, Hospital Universitario Basurto, Bilbao, Spain
| | | | - Eva Sierra-Moros
- Department of Gastroenterology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jesús Barrio
- Department of Gastroenterology, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Eduard Brunet-Mas
- Department of Gastroenterology, Hospital Universitari Parc Taulí, Sabadell and CIBEREHD, Barcelona, Spain
| | - Luis Bujanda
- Department of Gastroenterology, Hospital Universitario de Donostia, Biodonostia Health Research Institute, Universidad del País Vasco (UPV/EHU), and CIBEREHD, Donostia, Spain
| | - Fiorella Cañete
- Department of Gastroenterology, Hospital Universitario Germans Trias i Pujol, and CIBEREHD, Badalona, Spain
| | - Fernando Gomollón
- Department of Gastroenterology, Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón (IIS Aragón), and CIBEREHD, Zaragoza, Spain
| | | | - Iago Rodríguez-Lago
- Department of Gastroenterology, Hospital Universitario de Galdakao, Instituto de Investigación Sanitaria BioBizkaia, Vizcaya, Spain
| | | | - Beatriz Sicilia
- Department of Gastroenterology, Hospital Universitario de Burgos, Burgos, Spain
| | - Sandra Torra-Alsina
- Department of Gastroenterology, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Laura Arranz-Hernández
- Department of Gastroenterology, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Daniel Carpio
- Department of Gastroenterology, Complexo Hospitalario Universitario de Pontevedra, Pontevedra
| | | | | | - José María Huguet
- Department of Gastroenterology, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Lucía Márquez-Mosquera
- Department of Gastroenterology, Hospital del Mar and Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | | | - Ángel Ponferrada-Díaz
- Department of Gastroenterology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
| | - Javier P Gisbert
- Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-Princesa), Universidad Autónoma de Madrid (UAM), and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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Vuyyuru SK, Solitano V, Singh S, Hanzel J, Macdonald JK, Danese S, Peyrin Biroulet L, Ma C, Jairath V. Scoring Indices for Perianal Fistulising Crohn's Disease: A Systematic Review. J Crohns Colitis 2024; 18:836-850. [PMID: 38126903 DOI: 10.1093/ecco-jcc/jjad214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/20/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND AND AIMS In this systematic review we summarise existing scoring indices for assessing disease activity and quality of life in perianal fistulising Crohn's disease [PFCD], and highlight gaps in the literature. METHODS MEDLINE, EMBASE, and CENTRAL were searched from August 24, 2022, to identify studies evaluating clinical, radiological, or patient-reported outcome measures [PROMS] in PFCD. The primary objective was to identify all available scoring indices and describe the operating properties of these indices. RESULTS A total of 53 studies reported on the use of one clinical index [Perianal Disease Activity Index: PDAI], three PROMs, and 10 radiological indices; 25 studies evaluated the operating properties of these indices. The PDAI demonstrated content validity, construct validity, and responsiveness but criterion validity or reliability were not assessed. The Van Assche Index [VAI], modified VAI, and the Magnetic Resonance Index for Assessing Fistulas in Patients with CD [MAGNIFI-CD] were the most studied radiological indices. These indices demonstrated responsiveness and reliability. The VAI and MAGNIFI-CD demonstrated construct validity; criterion and content validity and feasibility have not been assessed. Among the three PROMs, the Crohn's Anal Fistula Quality of Life index demonstrated content and construct validity, inter-observer reliability, and responsiveness; criterion validity, intra-observer reliability, and feasibility have not been assessed for this index. CONCLUSIONS There are no fully valid, reliable, and responsive clinical disease or radiological indices for PFCD. Although the radiological indices demonstrated responsiveness and reliability, well-defined cut-offs for response and remission are lacking. Future research should focus on establishing standardised definitions and thresholds for outcomes.
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Affiliation(s)
- Sudheer K Vuyyuru
- Department of Medicine, Division of Gastroenterology, Schulich school of Medicine, Western University, London, ON, Canada
- Alimentiv Inc., 100 Dundas street, London, ON, Canada
| | - Virginia Solitano
- Department of Medicine, Division of Gastroenterology, Schulich school of Medicine, Western University, London, ON, Canada
- Alimentiv Inc., 100 Dundas street, London, ON, Canada
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Siddharth Singh
- Division of Gastroenterology, Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | - Jurij Hanzel
- Alimentiv Inc., 100 Dundas street, London, ON, Canada
- Faculty of Medicine, University of Ljubljana, Department of Gastroenterology, University Medical Center Ljubljana, Ljubljana, Slovenia
| | | | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele and University Vita-Salute San Raffaele, Milan, Italy
| | - Laurent Peyrin Biroulet
- Department of Gastroenterology, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- Inserm, NGERE, University of Lorraine, Nancy, France
- INFINY Institute, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- FHU-CURE, Nancy University Hospital, Vandœuvre-lès-Nancy, France
- Groupe Hospitalier Privé Ambroise Paré - Hartmann, Paris IBD Center, Neuilly sur Seine, France
- Division of Gastroenterology and Hepatology, McGill University Health Centre, Montreal, QC, Canada
| | - Christopher Ma
- Alimentiv Inc., 100 Dundas street, London, ON, Canada
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Vipul Jairath
- Department of Medicine, Division of Gastroenterology, Schulich school of Medicine, Western University, London, ON, Canada
- Alimentiv Inc., 100 Dundas street, London, ON, Canada
- Department of Epidemiology and Biostatistics and Robarts Research Institute, Western University, London, ON, Canada
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Khan SZ, Arline A, Williams KM, Lee MJ, Steinhagen E, Stein SL. The use of core descriptors from the ENiGMA code study in recent literature: a systematic review. Colorectal Dis 2024; 26:428-438. [PMID: 38296841 DOI: 10.1111/codi.16893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
AIM The heterogeneity in data quality presented in studies regarding Crohn's anal fistula (CAF) limit extrapolation into clinical practice. The ENiGMA collaborators established a core descriptor set to standardize reporting of CAF. The aim of this work was to quantify the use of these descriptors in recent literature. METHOD We completed a systematic review of PubMed and the Cochrane Library, extracting publications from the past 10 years specific to the clinical interventions and outcomes of CAF, and reported in line with PRISMA guidance. Each article was assessed for inclusion of ENiGMA descriptors. The median number of descriptors per publication was evaluated along with the overall frequency of each individual descriptor. Use of ENiGMA descriptors was compared between medical and procedural publications. RESULTS Ninety publications were included. The median number of descriptors was 15 of 37; 16 descriptors were used in over half of the publications while 17 were used in fewer than a third. Descriptors were more frequently used in procedural (n = 16) than medical publications (n = 14) (p = 0.031). In procedural publications, eight descriptors were more frequently used including Faecal incontinence, Number of previous fistula interventions, Presence and severity of anorectal stenosis and Current proctitis. Medical publications were more likely to include Previous response to biological therapy and Duration and type of current course of biological therapy. CONCLUSION With many descriptors being used infrequently and variations between medical and procedural literature, the colorectal community should assess the need for all 37 descriptors.
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Affiliation(s)
- Saher-Zahra Khan
- University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Andrea Arline
- Case Western Reserve University School of Medicine, Cleveland, USA
| | | | - Matthew J Lee
- Academic Directorate of General Surgery, Sheffield Teaching Hospitals NHS FT, Sheffield, UK
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, UK
| | - Emily Steinhagen
- University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
| | - Sharon L Stein
- University Hospitals Research in Surgical Outcomes and Effectiveness Center (UH-RISES), Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, USA
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Schroeder M, Abushamma S, George AT, Balakrishna R, Hickman J, Elumalai A, Wise P, Zulfiqar M, Ludwig DR, Shetty A, Viswanath SE, Luo C, Sebastian S, Ballard DH, Deepak P. Geldof Expert Consensus Classification of Perianal Fistulizing Crohn's Disease: A Real-World Application in a Serial Fistula MRI Cohort. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.03.24302160. [PMID: 38352377 PMCID: PMC10863007 DOI: 10.1101/2024.02.03.24302160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2024]
Abstract
Background and Aims Perianal fistulizing Crohn's disease (CD-PAF) is an aggressive phenotype of Crohn's disease (CD) defined by frequent relapses and disabling symptoms. A novel consensus classification system was recently outlined by Geldof et al. that seeks to unify disease severity with patient-centered goals but has not yet been validated. We aimed to apply this to a real-world cohort and identify factors that predict transition between classes over time. Methods We identified all patients with CD-PAF and at least one baseline and one follow-up pelvic (pMRI). Geldof Classification, disease characteristics, and imaging indices were collected retrospectively at time periods corresponding with respective MRIs. Results We identified 100 patients with CD-PAF of which 96 were assigned Geldof Classes 1 - 2c at baseline. Most patients (78.1%) started in Class 2b, but changes in classification were observed in 52.1% of all patients. Male sex (72.0%, 46.6%, 40.0%, p = 0.03) and prior perianal surgery (52.0% vs 44.6% vs 40.0%, p = 0.02) were more frequently observed in those with improved. Baseline pMRI indices were not associated with changes in classification, however, greater improvements in mVAI, MODIFI-CD, and PEMPAC were seen among those who improved. Linear mixed effect modeling identified only male sex (-0.31, 95% CI -0.60 to -0.02) with improvement in class. Conclusion Geldof classification highlights the dynamic nature of CD-PAF over time, however, our ability to predict transitions between classes remains limited and requires prospective assessment. Improvement in MRI index scores over time was associated with a transition to lower Geldof classification.
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Iqbal N, Sackitey C, Gupta A, Tolan D, Plumb A, Godfrey E, Grierson C, Williams A, Brown S, Maxwell-Armstrong C, Anderson I, Selinger C, Lobo A, Hart A, Tozer P, Lung P. The development of a minimum dataset for MRI reporting of anorectal fistula: a multi-disciplinary, expert consensus process. Eur Radiol 2022; 32:8306-8316. [PMID: 35732929 DOI: 10.1007/s00330-022-08931-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/08/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
Abstract
There are a range of sphincter-preserving procedures available to treat anorectal fistula, some of which can be precluded, or rendered more optimal by specific features of fistula anatomy. Magnetic resonance imaging (MRI) is the gold standard modality for assessing anorectal fistula. To maximise clinical utility, the MRI report should accurately describe these clinically relevant features. We aimed to develop a minimum dataset for reporting MRI of anorectal fistula, in order to improve the assessment and management of these patients. A longlist of 70 potential items for the minimum dataset was generated through systematic review of the literature. This longlist was presented to radiologists, surgeons and gastroenterologists in an online survey to understand the features that shape current clinical practice. The longlist and survey results were then presented to an expert consensus panel to generate the final minimum dataset through discussion and anonymous voting. The final minimum dataset details the general characteristics, features of the internal and external openings, path of the fistula through the sphincters and any associated extensions and collections that should be described in all MRI reports for anal fistula. Additional surgical and perianal Crohn's disease subsets were developed to indicate the features that aid decision-making for these patients, in addition to a minimum dataset for the clinical request. This study represents a multi-disciplinary approach to developing a minimum dataset for MRI reporting of anal fistula, highlighting the most important features to report that can assist in clinical decision-making. KEY POINTS: • This paper recommends the minimum features that should be included in all MRI reports for the assessment of anal fistula, including Parks classification, number of tracts, features of the internal and external opening, path of the tract through the sphincters, the presence and features of extensions and collections. • Additional features that aid decision-making for surgery or in the presence of Crohn's disease have been identified. • The items that should be included when requesting an MRI are specified.
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Affiliation(s)
- Nusrat Iqbal
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, London, UK
| | - Charlene Sackitey
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, London, UK
| | | | | | | | | | | | - Andrew Williams
- Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Steven Brown
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | | | | | | | - Alan Lobo
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Ailsa Hart
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, London, UK
| | - Phil Tozer
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, London, UK
| | - Phillip Lung
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, London, UK.
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