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P173. Predictors of long-term outcomes of perianal fistulizing Crohn's disease

B. Tchoundjeu1, T. Rohou2, G. Bouguen1, D. Cuen1, T. Wallenhorst1, I. Berkelmans1, Y. Gandon2, J.-F. Bretagne1, L. Siproudhis1, 1CHU Pontchaillou, Service des Maladies de l'Appareil Digestif, Rennes, France, 2CHU Pontchaillou, Fédération d'Imagerie Médicale, Rennes, France

Background

The treatment of perianal fistulizing Crohn's disease remains a challenge in clinical practice, requiring a combined medical and surgical approach which is often insufficient. The purpose of this study was to identify clinical and imaging based predictors of the long-term outcome of PCD.

Methods

All clinical (including Montreal classification, Harvey Bradshaw, PDAI, UFS) and radiographic (3T MRI) data of Crohn's disease at the time of management of PCD were recorded in a prospective database. Survival analysis was used to look for predictors of clinical and anatomical remission of the PCD.

Results

The analysis focused on the clinical outcomes of 122 events in 70 patients with PCD (H/F: 26/44), with a median age of 32 years, and complex fistula in 55 patients. Comparing MRI and clinical assessment of PCD, more than 90% of clinical fistulas (111/122) were identified using MRI. However the concordance of anatomical description between physical examination and imaging was fair: similar for just over half of PCD 71/122 (58.2%). After a median follow-up of 33 months (range 17–55), the cumulative probabilities of remission of PCD were 31% and 43%, at 24 and 36 months respectively. Of note, univariate analysis found a Van Assche score >15 was associated with a long-term non-healing fistula. Independent predictors of poor outcomes of PCD were tobacco use (HR 8.9 [2.8 to 40.8], p < 0.0001), female gender (HR = 7.1 [2.8 to 18.6], p < 0.0001), the presence of perianal lesions at the time of initial Crohn's disease diagnosis (HR = 2.9 [1.3 to 7.4], p < 0.007), the B1 phenotype, the lateral extension of PCD of more than 30% of the anorectal circumference (HR = 17.8 [5.7 to 58.3], p < 0.0001) and inflammatory disease of the rectal wall on MRI (HR = 6.5 [2.5 to 25.2], p < 0.0001).

Figure: Tobacco use and outcomes of Perianal Fistulizing Crohn's Disease.

Conclusion

Some MRI or clinical features are associated with a poor outcome of PCD. Physicians should consider these predictors when choosing therapies for PCD.