P685 Early use of infliximab after seton technique for patients with Crohn’s disease who initially presented with perianal fistulas

Abstract

Abstract Background Widespread early use of biologic agents cannot be recommended for all Crohn’s disease patients, but for patient subgroups with a predicted disabling course such as perianal fistulas, the early introduction of a biologic agent can be considered. The aim of this study was to assess the outcome of the early use of infliximab after seton technique for patients with Crohn’s disease who initially presented with perianal fistulas Methods We retrospectively reviewed charts of patients with Crohn's disease who initially presented with perianal fistulas between January 2020 and December 2021. After confirm diagnosis of CD by endoscopic examination, all patients underwent both seton procedure and infliximab therapy by single colorectal surgeon. After third injection of infliximab, we removed silastic seton at once, or, in the case of active fistula, replaced it with nylon, and then removed it when the fistula was in remission. Outcomes included clinical remission based on physical examination with radiologic examination (including sonogram and MRI) and endoscopic findings up to last follow up. Results Overall, 31 patients were identified, [29 males (94%), mean age at diagnosis of Crohn’s disease 21.2 (9-32) years]. Half of patients (15/31) showed moderate to severe bowel severity at pre-treatment colonoscopy. Mean number of fistulas was 1.6 (1-4). The overall number of primarily placed setons was 70, of which 33 were inserted through the primary opening and the other 37 were placed between secondary openings. The mean interval between seton insertion and introduction of infliximab was 17.2 (7-30) days. The number of patients who changed silastic seton to nylon was 11. The mean follow-up was 24 months. In 27 patients, Setons were completely removed until last follow up. Interval between seton insertion and complete removal was 7 months ranged from 3 to 24 months. In colonoscopy performed 1 year after infliximab introduction, luminal Crohn's disease of most patients was in endoscopic remission (20/31) or improved (11/31) and there were no case of exacerbation. In 3 patients, because of local sepsis or pain after seton removal, seton procedure was performed again. 30 patients were in clinical remission and had no anal discomfort. Conclusion Early use (within 30 days) of infliximab after seton technique was very effective for patients with Crohn’s disease who initially presented with perianal fistulas. Seton removal should be started at least after remission induction. And replacing silastic seton with nylon was a simple and effective method.