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P415. Perianal complete remission after combined therapy with seton placement and anti-TNF therapy for Crohn's disease: results of a Brazilian multicenter observational study

P.G. Kotze1, I.C. Albuquerque2, A.d.L. Moreira3, C.R. Coy4, W.B. Tonini1, G.S. Formiga2, R.F. Leal4, M.d.L.S. Ayrizono4, A.T.P. Carvalho5, M. Olandoski6, L.M.S. Kotze7, 1Catholic University of Parana, Colorectal Surgery Unit, Curitiba – PR, Brazil, 2Heliópolis Hospital, IBD clinics, São Paulo – SP, Brazil, 3UERJ, Colorectal Surgery Unit, Rio de Janeiro – RJ, Brazil, 4Unicamp, Colorectal Surgery Unit, Campinas – SP, Brazil, 5UERJ, Gastroenterology Unit, Rio de Janeiro – RJ, Brazil, 6Catholic University of Parana, Statistics, Curitiba – PR, Brazil, 7Catholic University of Parana, Gastroenterology unit, Curitiba – PR, Brazil

Background

Perianal fistulizing Crohn's disease (CD) is one of the most severe phenotypes of inflammatory bowel diseases (IBD). Combined therapy with examination under anesthesia, seton placement and anti-TNF therapy is the most common strategy for the management of this condition. There is scarce data regarding complete “healing” of the fistulae in these patients. The aim of this study was to analyze the rates of complete perianal remission after combined therapy for perianal fistulizing CD, as well as epidemiological characteristics of these patients.

Methods

This was a retrospective observational study that included Brazilian patients with perianal fistulizing CD submitted to combined therapy with examination under anesthesia and seton placement followed by anti-TNF therapy, from 4 IBD referral centers, from January 2009 to June 2012. Electronic chart review was performed and data were inputed in a specific protocol. We analyzed patients' demographic characteristics, Montreal classification, concomitant medication, type of biological agent, classification of the fistulae, occurrence of perianal complete remission, number of setons placed, timing of seton withdrawal and recurrence after remission. Complete perianal remission was defined as abscense of drainage from the fistula tracks associated with seton removal. Remission and recurrence rates were analyzed with confidence intervals (CI) of 95% and the timing of recurrence was analyzed in a Kaplan–Meier curve.

Results

A total of 78 patients were included, 44 females (55.8%) with a mean age of 33.8 (±15) years. Medium time of CD diagnosis was 88.9 (±76.8) months. Montreal Classification: age at diagnosis (A1 = 21.8%, A2 = 50% and A3 = 28.2%); disease location (L1 = 0%, L2 = 7.7%, L3 = 78.2% and L4 = 14.1%); disease phenotype (B3 in 100% of the cases). Azathioprine was used in combination with the anti-TNF agents in 76.6% of the cases, 66.2% of the patients were treated with Infliximab (IFX) and 33.8% with Adalimumab (ADA). Complex fistulae were found in 52/78 patients (66.7%). After a medium follow-up period of 48.2 months, 41/78 patients (52.6%) had complete perianal remission (95% CI: 43.5–63.6%). Recurrence occurred in 4 (9.8%) patients (95% CI: 0.7–18.8%) in an average period of 74.8 months.

Conclusion

After combined surgery with seton placement and anti-TNF therapy, 52.6% of the patients had complete perianal remission an only 9.8% had recurrence. These results demonstrate the clear benefits of this approach in perianal fistulizing CD.