Presenter of 1 Presentation
PG 3.1 - What the gastroenterologist and surgeon need to know
Abstract
Learning objectives
To learn about the pathogenesis and prevalence of perianal fistulas in Crohn’s diseaseTo become familiar with non-surgical and surgical treatment options in patients with perianal Crohn’s disease
To know what to report to help gastroenterologists and surgeons determine the optimal treatment
Video-on-demand
Presenter of 1 Presentation
PG 3.1 - What the gastroenterologist and surgeon need to know
Abstract
Learning objectives
To learn about the pathogenesis and prevalence of perianal fistulas in Crohn’s diseaseTo become familiar with non-surgical and surgical treatment options in patients with perianal Crohn’s disease
To know what to report to help gastroenterologists and surgeons determine the optimal treatment
Author of 1 Presentation
SS 6.1 - MRI after ligation of the intersphincteric fistula tract for high perianal fistulas in Crohn’s disease: a retrospective cohort study (ID 403)
Abstract
Purpose
Surgical closure of high perianal fistulas using ligation of the intersphincteric fistula tract (LIFT) procedure is increasingly used in Crohn’s disease. Currently, data on postoperative MRI findings are lacking, while important to assess deep healing. Therefore, we aimed to evaluate fistula characteristics on MRI and the relation with clinical outcomes after LIFT procedure.
Material and methods
Consecutive Crohn’s patients treated with LIFT between 2007 and 2018 for high perianal fistulas who underwent baseline and follow-up MRI were retrospectively included. MRIs were scored by two radiologists according to items based on the original and modified Van Assche indices. MRI findings and the relation towards clinical healing were described.
Results
Twelve patients were included (4 male, median age 34 years (IQR 28-39)). Follow-up MRI was performed, median 5.5 months (IQR 2.5-6.0) after LIFT. At this time, eight patients (67%) showed clinical healing, which increased to ten (83%) during follow-up, none had a recurrence. Three patients (25%) needed a re-intervention due to inflammatory masses and/or persisting fistulas. At baseline, all patients showed a tract predominantly filled with granulation tissue, which changed to fibrotic in seven (58%). All clinically responding patients showed a decrease in tract volume and/or hyperintensity with the absence of hyperintensity (T1 and T2) in four (33%) patients.
Conclusion
Clearly decreased fistula activity can be observed on MRI after LIFT surgery in Crohn’s patients. A large proportion of patients develops a fibrotic tract relatively soon after LIFT and shows no clinical recurrences, suggesting a highly effective therapy and prognostic value of MRI.