Discordance between Deep Remissions Assessed by MRI and Long-term Clinical Remission after Combined Therapy with Infliximab and Seton Placement for Perianal Fistulizing Crohn's Disease

Mengci Zhang, Lichao Qiao, Xin Zhu, Ping Zhu, Yunfei Gu, Jing Li, Bolin Yang, Hongjin Chen

Department of Colon and Rectum Surgery, Nanjing University of Chinese Medicine, China
Department of Radiology, Nanjing University of Chinese Medicine, China

^*Correspondance to: Hongjin Chen 

 PDF  Full Text DOI: 10.25107/2474-1647.2321

Abstract

Objective: To investigate the correlation between deep remissions assessed by Magnetic Resonance Imaging (MRI) and long-term clinical remission after combined therapy for Perianal Fistulizing Crohn’s Disease (PFCD).Methods: This was a retrospective study. Patients with PFCD undergoing combined therapy who performed pelvic MRI before surgery and at the final follow-up were included in this study. The correlation between deep remission and long-term clinical remission was investigated. A logistic regression model was used to evaluate individual items in the Van Assche scoring system as well as other factors that may affect deep remission.Results: Total of 57 eligible patients (men 68.4%) with PFCD was included in this study. The median follow-up period was 34.5 (IQR 22-58) months. The long-term clinical remission rate and response rate were 57.9% (33/57) and 42.1% (24/57), respectively. Among the 33 patients with long-term clinical remission, 16 (48.5%) achieved deep remission, as assessed by MRI. Univariate and multivariate analysis showed that IFX maintenance treatment ≤ 3 times (OR=4.30, 95% CI: 1.16-15.94) and fistula with a secondary track (OR=4.38, 95% CI: 1.12-17.04) were risk factors for deep remission; fistula located below the levator ani muscle (OR=0.18, 95% CI: 0.04-0.82) was a protective factor for deep remission.Conclusion: There is discordance between deep remission assessed by MRI and long-term clinical remission after combined therapy for PFCD. Only half of patients with long-term remission can achieve deep remission. IFX maintenance treatment >3 times and fistula without secondary tract and located below the levator ani muscle are predictive factors for deep remission.

Keywords

Crohn’s disease; Anal fistula; Long-term clinical remission; Deep remission; Predictive factors

Cite the article

Zhang M, Qiao L, Zhu X, Zhu P, Gu Y, Li J, et al. Discordance between Deep Remissions Assessed by MRI and Long-term Clinical Remission after Combined Therapy with Infliximab and Seton Placement for Perianal Fistulizing Crohn's Disease. Clin Surg. 2019; 4: 2321.