451 An Assessment of Clinical Outcomes of Combined Seton Placement and Infliximab in Perianal Fistulising Crohn’s Disease

Aim

Perianal fistulising Crohn’s disease (PFCD) is a severe, disabling complication that causes increased morbidity and occurs in approximately 30% of Crohn’s patients. It has a detrimental impact on patients' lives and their abilities to complete their activities of daily living.

The NICE guidelines and various studies demonstrate that combined therapy accelerates primary closure of the perianal fistulae. We assess the clinical outcomes (response rate and recurrence risk) of combined use of Seton placement with anti-TNF therapy (Infliximab) in the treatment of PFCD via a metanalysis of multiple scientific studies over the last 20 years.

Method

Electronic databases, PubMed and Google Scholar, were used for literature search. Key terms (such as perianal fistula, Crohn’s disease, Seton placement, Infliximab) were applied. Of the 34 articles obtained, analysis of the key findings from four peer-reviewed primary sources are presented.

Results

In all studies, best clinical outcomes were obtained when abscess drainage was done in conjunction with induction therapy with Infliximab (5mg/kg) at 0, 2 and 6 weeks. Reguiero et al (2003) obtained 100% fistula closure rates in patient group receiving combined therapy (9/32) as compared to 89% the patient group receiving Infliximab alone (23/32, 89%); other studies also found improved response rates of the fistula in their patients, ranging from in 66% to 77%.

Conclusions

Overall, from the results of the studies, combined use of Seton placement and infliximab significantly improve clinical outcomes in patients with complex PFCD as measured through the reduction in recurrence risk and improved fistula closure rate.