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P217. Local injection of infliximab in severe fistulating perianal Crohn's disease: Long-term follow-up

L. Alessandroni1, A. Kohn1, R. Cosintino1, M. Marrollo1, C. Papi2, R. Monterubbianesi1, R. Tersigni1

1A.O.S. Camillo-Forlanini, Rome, Italy; 2A.O.S. Filippo Neri, Rome, Italy

Aim: Perianal fistulas are a frequent complication of Crohn's disease that can result in significant morbidity and low quality of life; its management is difficult and controversial and can involve costly medical and surgical treatments. Infliximab, a chimeric anti-TNF alfa monoclonal antibody, has been shown to control perianal sepsis and promote closure of enteric and perianal fistulas. Recently, intraoperative local injections of Infliximab associated to surgical treatment of local sepsis and placing of loose setons, have been proposed for patients intolerant or non-responder to intravenous Infliximab.

Materials and Methods: We treated with this approach twelve patients, 4 females and 8 males, with a median age of 33 years, affected by Crohn's disease with severe/complex perianal fistulas refractory to other treatments.

Results: No local and/or general adverse effects were observed. Eight patients (66.6%) completed the treatment and presented complete closure of the fistula tracks, tested with probe examination after setons removal and magnetic resonance of the perineum. Four patients (33.4%) stopped the treatment, one for refuse of continue the cure, one for pregnancy, and two for relapse of intestinal symptoms. In the healed group, the closure of the fistulas was obtained after a median of 5 injections (range 3–7), and was maintained at one-year follow-up in 7 out of 8 patients (87.5%). The median time of follow-up for the 8 patients who achieved the complete healing of all fistula tracts was 35 months (range 19–43 months): three patients (37.5%) had a complete clinical and radiological healing of the fistulas, two patients (25%) presented persistent asymptomatic lesions and three (37.5%) had a clinically relevant relapse of anal disease. The median PDAI at baseline, for all the 12 patients, was 9.6 (range 7–14); at the end of treatment and one year after the median PDAI was 4.5 and 2.5, respectively.

Conclusions: Surgery treatment and concomitant repeated local injection of Infliximab along fistula tract seem to be an effective and safe approach for the treatment of fistulizating perianal Crohn's disease, but the procedure can't protect from late relapse of anal disease. However, further controlled clinical trials are warranted to define the role of the treatment.