1. Surgical closure, mainly with glue injection and anti-tumour necrosis factor alpha, in fistulizing perianal Crohn's disease: A multicentre randomized controlled trial
- Author
-
Dominique Bouchard, Béatrice Vinson Bonnet, Guillaume Meurette, Cécile Train, Charlène Brochard, Pauline Roumeguère, Laurent Siproudhis, Laurent Abramowitz, Jean Marie Fayette, François Pigot, Ghislain Staumont, Hélène Pillant, Guillaume Bonnaud, A. Senéjoux, Jean Luc Faucheron, AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHU Pontchaillou [Rennes], Centre d'Investigation Clinique [Rennes] (CIC), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Maison de Santé Protestante de Bordeaux-Bagatelle (MSPB), Clinique Tivoli Ducos [Bordeaux], Hôpital Léopold-Bellan, CHI Poissy-Saint-Germain, Centre Hospitalier Universitaire [Grenoble] (CHU), CHP Saint Grégoire, Hôpital Ambroise Paré [AP-HP], Centre hospitalier universitaire de Nantes (CHU Nantes), ClinSearch [Malakoff, France], Clinique Saint-Jean Languedoc [Toulouse] (CSJL), Abbvie Laboratory AbbVie, and Université de Rennes (UR)-Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
medicine.medical_specialty ,Fistula ,[SDV]Life Sciences [q-bio] ,fistulizing perianal ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Crohn Disease ,Randomized controlled trial ,law ,medicine ,Adalimumab ,Humans ,Rectal Fistula ,Abscess ,GLUE ,Perianal Crohn's disease ,Crohn's disease ,business.industry ,Anti tumour necrosis factor ,Gastroenterology ,[SDV.MHEP.HEG]Life Sciences [q-bio]/Human health and pathology/Hépatology and Gastroenterology ,medicine.disease ,surgical closure ,3. Good health ,Surgery ,seton removal ,Treatment Outcome ,030220 oncology & carcinogenesis ,Drainage ,030211 gastroenterology & hepatology ,business ,medicine.drug - Abstract
Clinical trial registration: ClinicalTrials.gov Identifier NCT01388257; International audience; Aim In patients with fistulizing perianal Crohn's disease (CD), the need for a secondary surgical step is not defined. The aim was to assess the efficacy of surgical closure compared to a single seton removal in patients with drained fistulizing perianal CD treated with adalimumab. Methods This was a multicentre, randomized controlled trial, comparing seton removal + surgical closure (closure group) to seton removal alone (control group) with a stratification according to the American Gastroenterological Association classification. The primary end-point was fistula closure at month 12 defined by the association of the following criteria: no seton, absence of a visible external opening, absence of discharge from the tract after finger compression, absence of an internal opening, absence of perianal pain/abscess and absence of fistula-related abnormalities. Results Among the 64 included patients (262 expected) (48 complex fistula, 75%), 33 were randomized to the closure group and 31 to the control group. In the closure group, 26 patients (78.8%) had glue. At month 12, overall fistula closure was achieved in 35 of the evaluable 58 patients (60%): 18/32 (56%) in the surgery group and 17/26 (65%) in the control group (P = 0.479). In the closure group, fistula closure was observed in 13/25 (52%) and 5/7 (71%) patients with complex and simple fistula respectively (P = 0.426), compared with 12/18 (67%) and 5/8 (63%), respectively in the control group (P = 1.000). Conclusions Seton removal alone seems to be no more effective than a secondary surgical step (in particular glue injection) in patients having fistulizing perianal CD controlled by an initial drainage combined with adalimumab. The results should be interpreted with caution.
- Published
- 2021
- Full Text
- View/download PDF