Abstract
From 30 to 70% of patients with Crohn's disease (CD) may develop perianal fistulas during their lifetime. The medical and surgical management of this complication is challenging, and its treatment still gives unsatisfactory results. However, recent studies on adipose-derived mesenchymal stem cells have proven their anti-inflammatory and immuno-modulatory potential, representing a new promising tool in the treatment of such stubborn disease. We report our initial experience with three patients who had recurrent perianal CD treated with local infiltration of stem cell darvadstrocel (Alofisel). All the patients had a long history of perianal disease refractory to multiple medical and surgical treatments. The preoperative workup included transperineal ultrasound (TP-US), pelvic MRI, and colonoscopy that ruled out active proctitis in all the patients. The post-treatment follow-up included clinical assessment at 1, 3, and 6 months with repeated MRI and TP-US at 6 months. At 6 months, 2 patients had a clinical response despite radiological persistence of fistula tracts, while one patient presented perianal fistula recurrence complicated by perianal abscess. Although our experience is limited to 3 patients and a short follow-up, our results confirm that darvadstrocel injection is a safe procedure, with a good clinical response in most of the patients, but that it apparently had no effect on the anatomical modification of the fistula tracts. Long-term results, with a rigorous assessment of anatomical lesions, are still needed to support the promising data of the literature.
Highlights
The perianal fistulizing disease is a striving condition that is quite common in patients with Crohn’s disease (CD) during their lifetime
We report our initial experience with three patients who had recurrent perianal Crohn’s disease subjected to local infiltration of stem cell darvadstrocel (Alofisel)
After providing written informed consent, an examination under general anesthesia (EUA) of the perineal region was performed on each patient
Summary
The perianal fistulizing disease is a striving condition that is quite common in patients with Crohn’s disease (CD) during their lifetime. It can sometimes make the therapeutic management of a patient very difficult, requiring multiple surgical procedures but with frequently disappointing results in terms of recurrence and quality of life. Diagnosis and management of perianal CD require an expert, multidisciplinary approach, and even in tertiary inflammatory bowel disease (IBD) centers its treatment remains a challenge, with around 40% of patients experiencing refractory disease. Surgical intervention remains a cornerstone of management of perianal fistulizing disease with different techniques and approaches proposed in the literature. After adequate medical control of luminal disease, the established goal is to heal the fistula by preservation of fecal continence
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