The role of multimodal treatment in Crohn′s disease patients with perianal fistula : a multicentre retrospective cohort study

Abstract

Background: Treatment paradigms for Crohn′s disease with perianal fistulae (CD‐ pAF) are evolving. Aims: To study the impact of multimodality treatment in CD‐pAF on recurrence rates and the need for re‐interventions and to identify predictive factors for these outcomes. Methods: This was a multinational multicentre retrospective cohort study. Multimodality approach was defined as using a combination of medical treatments (anti‐TNFs ± immunomodulators ± antibiotics) along with surgical approach (examination under anaesthesia (EUA) ± seton drainage) at diagnosis of CD‐pAF. Univariable and multivariable analyses were performed for variables indicative of the need for reintervention. Results: A total of 253 patients were included. 65% of patients received multimodality approach. Multimodality treatment resulted in complete fistula healing in 52% of patients. Re‐intervention was needed in 27% of patients with simple and in 40.3% of those with complex fistula. On multivariable analysis multimodality treatment (OR: 0.35, 95% CI: 0.17‐0.57, P = 0.001), seton removal (OR: 0.090, 95% CI: 0.027‐0.30, P = 0.0001, therapy with infliximab (OR: 0.19, 95% CI: 0.06‐0.64, P = 0.007), and therapy with adalimumab (OR: 0.12, "95% CI: 0.026‐0.56, P = 0.007) were predictive of avoiding repeat surgery. Proctitis (OR: 3.76, 95% CI: 1.09‐12.96, P = 0.03) was predictive of the need for radical surgery (proctectomy, diverting stoma) while multimodality treatment reduced the need for radical surgery (OR: 0.21, 95% CI: 0.05‐0.81, P = 0.02). Conclusions: Multimodality treatment, anti‐TNFs use, and removal of setons after multimodality treatment can result in improved outcomes in CD patients with peri-anal fistulae and reduce the need for repeat surgery and radical surgery.