Chapter 16 - Endoscopic Therapy for the Treatment of Inflammatory Bowel Disease-Related Fistula, Sinus, and Abscess

Abstract

Both forms of inflammatory bowel diseases (IBDs), that is, Crohn's disease (CD) and ulcerative colitis (UC), can be complicated by the formation of fistula and abscess. In addition, surgery for CD or UC results in adverse sequelae of acute and chronic anastomotic leak, fistula, or abscess. While IBD-associated or IBD surgery–associated fistula or abscess has been traditionally treated with medical and/or surgical therapy, the role of endoscopic therapy has recently been explored is expanding, thanks to our better understanding of etiopathogenesis and natural history of IBD, principle of treatment, as well as advanced endoscopic techniques. There are important principles in endoscopic management of fistula, sinus, and abscess. Attempts should be made to temporarily or permanently close the feeding side (or the primary) orifice and open up the exit site (or the secondary) orifice of the fistula. In contrast, the opening of an anastomotic sinus should be cut open. Endoscopic techniques include fistulotomy, sinusotomy, fistula closure, endoscopy-guided drainage catheter placement. For disease-related fistula, a combined therapy with medical treatment is often required. For complex fistula and abscess, a multidisciplinary approach is a must. The role of self-expandable metal stent in the treatment of fistula remains to be investigated.