Mengci Zhang1, Lichao Qiao1, Xin Zhu2, Ping Zhu2, Yunfei Gu2, Jing Li2, Bolin Yang1, Hongjin Chen1*
1Department of Colon and Rectum Surgery, Nanjing University of Chinese Medicine, China
2Department of Radiology, Nanjing University of Chinese Medicine, China
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.
Crohn’s disease; Anal fistula; Long-term clinical remission; Deep remission; Predictive factors
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.