Annals of Coloproctology

Original Articles

Evaluation of a Seton Procedure Combined With Infliximab Therapy (Early vs. Late) in Perianal Fistula With Crohn Disease: Myunghoon Jeon, Kihwan Song, Jail Koo, Sohyun Kim; Ann Coloproctol. 2019;35(5):249-253. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2018.11.23.1

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Purpose
We assessed the clinical outcomes of a seton procedure combined with early versus late institution of infliximab (IFX) therapy.
Methods
This retrospective study comprised 76 patients who underwent surgery for perianal fistula associated with Crohn disease between January 2014 and November 2017. All patients underwent loose seton drainage combined with IFX therapy. Patients categorized as the early group (EG, 49 patients) received IFX therapy within 30 days of completion of the seton procedure. Patients categorized as the late group (LG, 27 patients) received IFX therapy >30 days after the seton procedure. IFX therapy was administered as induction and maintenance therapy.
Results
There were no statistically significant intergroup differences in clinical characteristics of the patients. The mean follow-up was 21.0 ± 11.6 months in the EG and 34.5 ± 18.4 months in the LG (P = 0.001). The mean interval between seton procedure and IFX induction therapy was 12.2 days in the EG and 250.2 days in the LG (P = 0.002). Complete remission was observed in 32 patients (65.3%) in the EG and 17 patients (63.0%) in the LG (P = 0.844). Fistula recurrence was observed in 6 patients (7.9%). All recurrences occurred in a previous perianal fistula tract.
Conclusion
Patients showed a good response to a seton procedure combined with IFX therapy regardless of the time of initiation of IFX therapy.

Citations

Citations to this article as recorded by

Management of Perianal Fistulizing Crohn’s Disease
Arshdeep Singh, Vandana Midha, Gursimran Singh Kochhar, Bo Shen, Ajit Sood
Inflammatory Bowel Diseases.2024; 30(9): 1579. CrossRef
The use of core descriptors from the ENiGMA code study in recent literature: a systematic review
Saher‐Zahra Khan, Andrea Arline, Kate M. Williams, Matthew J. Lee, Emily Steinhagen, Sharon L. Stein
Colorectal Disease.2024; 26(3): 428. CrossRef
Impact of Seton Use on Clinical, Patient-Reported, and Healthcare Resource Utilization Outcomes in Complex Crohn’s Perianal Fistulas: A Systematic Literature Review
Ian White, Chitra Karki, Parnia Geransar, Lilia Leisle, Sophia Junker, Phillip Fleshner
Inflammatory Bowel Diseases.2024;[Epub] CrossRef
The Optimal Management of Fistulizing Crohn’s Disease: Evidence beyond Randomized Clinical Trials
Panu Wetwittayakhlang, Alex Al Khoury, Gustavo Drügg Hahn, Peter Laszlo Lakatos
Journal of Clinical Medicine.2022; 11(11): 3045. CrossRef
The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anorectal Abscess, Fistula-in-Ano, and Rectovaginal Fistula
Wolfgang B. Gaertner, Pamela L. Burgess, Jennifer S. Davids, Amy L. Lightner, Benjamin D. Shogan, Mark Y. Sun, Scott R. Steele, Ian M. Paquette, Daniel L. Feingold
Diseases of the Colon & Rectum.2022; 65(8): 964. CrossRef
Management of perianal fistula in inflammatory bowel disease: identification of prognostic factors associated with surgery
Sara Gortázar de Las Casas, Mario Alvarez-Gallego, Jose Antonio Gazo Martínez, Natalia González Alcolea, Cristina Barragán Serrano, Aitor Urbieta Jiménez, María Dolores Martín Arranz, Jose Luis Marijuan Martín, Isabel Pascual Migueláñez
Langenbeck's Archives of Surgery.2021; 406(4): 1181. CrossRef
Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon’s Point of View
Jong Lyul Lee, Yong Sik Yoon, Chang Sik Yu
Annals of Coloproctology.2021; 37(1): 5. CrossRef
Multidisciplinary management of perianal Crohn's disease
Suha Abushamma, David H. Ballard, Radhika K. Smith, Parakkal Deepak
Current Opinion in Gastroenterology.2021; 37(4): 295. CrossRef
Approach to medical therapy in perianal Crohn’s disease
Abhinav Vasudevan, David H Bruining, Edward V Loftus, William Faubion, Eric C Ehman, Laura Raffals
World Journal of Gastroenterology.2021; 27(25): 3693. CrossRef
Infliximab

Reactions Weekly.2020; 1785(1): 284. CrossRef
Mesenchymal stem cells in perianal Crohn’s disease
H. Guadalajara, M. García-Arranz, M. Dolores Herreros, K. Borycka-Kiciak, A. L. Lightner, D. García-Olmo
Techniques in Coloproctology.2020; 24(8): 883. CrossRef

Long-term Outcomes and Risk Factors for Reoperation After Surgical Treatment for Gastrointestinal Crohn Disease According to Anti-tumor Necrosis Factor-α Antibody Use: 35 Years of Experience at a Single Institute in Korea: Sang Mok Lee, Eon Chul Han, Seung-Bum Ryoo, Heung-Kwon Oh, Eun Kyung Choe, Sang Hui Moon, Joo Sung Kim, Hyun Chae Jung, Kyu Joo Park; Ann Coloproctol. 2015;31(4):144-152. Published online August 31, 2015; DOI: https://doi.org/10.3393/ac.2015.31.4.144

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Abstract PDF

Purpose

Crohn disease is characterized by high rates of recurrence and reoperations. However, few studies have investigated long-term surgical outcomes in Asian populations. We investigated risk factors for reoperation, particularly those associated with anti-tumor necrosis factor-α (anti-TNF-α) antibody use, and long-term follow-up results.

Methods

We reviewed the records of 148 patients (100 males and 48 females) who underwent surgery for gastrointestinal Crohn disease and retrospectively analyzed long-term outcomes and risk factors.

Results

The mean age at diagnosis was 28.8 years. Thirty-eight patients (25.7%) received monoclonal antibody treatment before reoperation. A small bowel and colon resection was most commonly performed (83 patients, 56.1%). The median follow-up was 149 months, during which 47 patients underwent reoperation. The median interval between the primary and the secondary surgeries was 65 months, with accumulated reoperation rates of 16.5%, 31.8%, and 57.2% after 5, 10, and 15 years, respectively. Obstruction was the most common indication for reoperation (37 patients, 25.0%). In a multivariable analysis, age <17 years at diagnosis (A1) (odds ratio [OR], 2.20; P = 0.023), penetrating behavior (B3) (OR, 4.39; P < 0.001), and no azathioprine use (OR, 2.87; P = 0.003) were associated with reoperation. Anti-TNF-α antibody use did not affect the reoperation rate (P = 0.767).

Conclusion

We showed a high reoperation rate regardless of treatment with anti-TNF-α antibody, which indicates that recurrent surgery is still needed to cure patients with gastrointestinal Crohn diseases. Younger age at primary operation, penetrating behavior, and no azathioprine use were significant factors associated with reoperation for gastrointestinal Crohn disease.

Citations

Citations to this article as recorded by

Inflammatory Bowel Disease Reoperation Rate Has Decreased Over Time If Corrected by Prevalence
Mafalda Santiago, Fernando Magro, Luís Correia, Francisco Portela, Paula Ministro, Paula Lago, Eunice Trindade, Cláudia Camila Dias
Clinical and Translational Gastroenterology.2020; 11(9): e00227. CrossRef
Effect of Thiopurine on Potential Surgical Intervention in Crohn’s Disease in Korea: Results from the CONNECT Study
Hee Man Kim, Jin Woo Kim, Hyun-Soo Kim, Joo Sung Kim, You Sun Kim, Jae Hee Cheon, Won Ho Kim, Byong Duk Ye, Won Moon, Sung Hee Jung, Young-Ho Kim, Dong Soo Han
Journal of Clinical Medicine.2020; 10(1): 25. CrossRef
Risk factors for postoperative surgical site infections in patients with Crohn’s disease receiving definitive bowel resection
Song Liu, Ji Miao, Gefei Wang, Meng Wang, Xiuwen Wu, Kun Guo, Min Feng, Wenxian Guan, Jianan Ren
Scientific Reports.2017;[Epub] CrossRef
Advanced age impacts surgical characteristics and postoperative course in patients with Crohn's disease
Stanislaus Argeny, Anton Stift, Martina Mittlböck, Amy C. Lord, Svenja Maschke, Mathias Schneeweiß, Stefan Riss
International Journal of Surgery.2016; 33: 182. CrossRef
Effect of Tripterygium Wilfordii Polyglycoside on Experimental Prostatitis Caused by Ureaplasma Urealyticum in Rats
Pingnan Shan, Zhiyong Lu, Lihong Ye, Yaqin Fang, Suhong Tan, Guohong Xuan, Jincheng Ru, Liming Mao
Medical Science Monitor.2016; 22: 3722. CrossRef
Endoscopy-based management decreases the risk of postoperative recurrences in Crohn’s disease
Anne-Laure Boucher, Bruno Pereira, Stéphanie Decousus, Marion Goutte, Felix Goutorbe, Anne Dubois, Johan Gagniere, Corinne Borderon, Juliette Joubert, Denis Pezet, Michel Dapoigny, Pierre J Déchelotte, Gilles Bommelaer, Anthony Buisson
World Journal of Gastroenterology.2016; 22(21): 5068. CrossRef
Anti-tumor Necrosis Factor Therapy for Crohn Disease: Friend or Foe to the Surgeon?
Hungdai Kim
Annals of Coloproctology.2015; 31(4): 121. CrossRef

Case Report

Primary Signet-ring-cell Carcinoma of the Right and the Sigmoid Colon in Crohn's Disease.: Kim, Hyoung Ran , Lee, In Kyu , Lee, Yoon Suk , Park, Jong Kyung , Oh, Seong Taek , Kim, Jun Gi , Lee, Kyungji , Park, Gyeoung Sin , Jung, Seong Eon , Park, Soo Heon , Chang, Suk Kyun; J Korean Soc Coloproctol. 2006;22(3):204-209.

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Abstract PDF: A 31-year-old woman with a 5-year history of Crohn's disease was admitted to our hospital because of recurrent right lower quadrant pain and diarrhea. Abdominal computed tomography showed multiple fistulas between the terminal ileum, the sigmoid colon, and the cecum, and mucosal wall thickenings due to an active inflammatory process and mucosal enhancements. Colonoscopic examinations showed a finger-like projection of a polypoid mass at the ileocecal valve, long-neck, finger-like pseudopolyps at the cecum, and soft, lumen narrowing and multiple pseudopolyps at the sigmoid colon and the intact rectum. There was healing scarring of the anal fistula. These findings were compatible with those of Crohn's disease. Histologic findings were chronic inflammation with erosion and regenerative crypt epithelium. The patient underwent infliximab therapy. She underwent a right colectomy, a Hartman's procedure, and a small bowel segmental resection due to multiple fistulas. The pathologic diagnosis was a signet-ring-cell carcinoma with non-caseating granuloma in the ascending colon, ileum, and sigmoid colon. We report this case of Crohn's disease associated with a colonic signet-ring cell carcinoma.

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