Fibrin glue heals perianal fistulas in Crohn’s disease patients
MedWire News: Fibrin glue is a simple, well tolerated, and effective treatment for perianal fistulas in patients with Crohn’s disease (CD), report researchers.
Previous research indicates that perianal fistulas occur in approximately one in four CD patients.
“They represent a difficult therapeutic challenge and a source of physical and psychologic morbidity with a long-term risk of proctectomy,” say Jean-Charles Grimaud (Université Méditerranée, Marseille, France) and co-investigators.
In this study, Grimaud and team tested the efficacy of fibrin glue injection, which uses the activation of thrombin to form a fibrin clot and seal the fistula tract, for treatment of perianal fistula in 36 randomly selected CD patients (CD activity index of 250 or less) with simple (n=20) or complex (n=16) fistula after seton removal. They also randomly selected 41 CD patients to form an observation only or control group, of whom 21 had complex and 20 simple fistulas.
The participants were followed up at 4, 8, and 16 weeks to assess draining, perianal pain, and presence or absence of perianal abscess, with a primary study endpoint of clinical remission, defined as the absence of draining pain, and abscess, at week 8.
As reported in the journal Gastroenterology, clinical remission was observed in 38% of the fibrin glue group at 8 weeks compared with only 16% of the observation group. Use of fibrin glue increased the chance of clinical remission from perianal fistula at 8 weeks 3.2-fold compared with observation alone.
The researchers note that the benefit seemed to be greater for those with simple, compared with complex, fistula.
The frequency and severity of adverse events did not differ significantly between the two groups.
“Fibrin glue appears a simple, effective, and well-tolerated therapeutic option in perianal fistulas of patients with CD,” conclude the authors.
“In our opinion, fibrin glue could be attempted before considering more complex and aggressive surgical procedures such as fistulotomy or endorectal advancement flaps,” they suggest.
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By Helen Albert