Autologous Microfragmented Adipose Tissue Injection in Refractory Complex Crohn's Perianal Fistulas: Long-Term Results at 6.7 Years Mean Follow-up.

IF 4.5 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Inflammatory Bowel Diseases Pub Date : 2024-12-05 DOI:10.1093/ibd/izae283
Silvio Laureti, Alberta Cappelli, Claudio Isopi, Lorenzo Gentilini, Riccardo Villani, Gioia Sorbi, Fernando Rizzello, Alessandra Menon, Nikolas Konstantine Dussias, Paolo Gionchetti, Gilberto Poggioli
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Abstract

Background: Nowadays, there is a clear need for new viable therapeutic options to face complex perianal Crohn's disease (PCD). Results of our previous pilot study demonstrated the efficacy and safety of local injection of autologous microfragmented adipose tissue (MFat) in this setting. This study aims to evaluate the long-term follow-up results in the same cohort of patients.

Methods: Data on clinical and radiological remission and surgical recurrence rates were prospectively collected on the 15 patients with complex fistulizing PCD refractory to combined bio-surgical therapy, originally treated with local MFat injection, with a mean 6.7 years follow-up.

Results: In our previous study, at 24-week follow-up, combined remission was reported in 66.7% of patients, while clinical remission was achieved in 93% of cases. At a 6.7-year follow-up, 9 of the 10 healed patients maintained remission. The patient with recurrence was successfully reoperated. Three out of 5 patients who failed primary combined remission were retreated, with 2 obtaining combined remission and 1 failing. One patient refused any subsequent treatment due to good quality of life. The last patient presented delayed healing at a 1-year follow-up. Overall success rate after rescue therapy at the final follow-up reached 86.6%. Safety was maintained throughout all follow-up periods.

Conclusions: This is the longest follow-up published trial on MFat injection for PCD. Our results show that patients who achieved closure in the first 24 weeks sustained response at long-term evaluation. In addition, there may be a rationale in repeating treatment as rescue therapy in not responding to patients.

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自体微碎片脂肪组织注射治疗难治性复杂克罗恩病肛周瘘:平均随访 6.7 年的长期结果。
背景:如今,面对复杂的肛周克罗恩病(PCD),显然需要新的可行治疗方案。我们之前的试点研究结果表明,在这种情况下局部注射自体微碎屑脂肪组织(MFat)具有良好的疗效和安全性。本研究旨在评估同一批患者的长期随访结果:方法:前瞻性地收集了15例生物外科联合疗法难治的复杂瘘管型PCD患者的临床和放射学缓解率以及手术复发率的数据,这些患者最初接受了局部注射MFat治疗,平均随访6.7年:在我们之前的研究中,在 24 周的随访中,66.7% 的患者获得了综合缓解,93% 的病例获得了临床缓解。在 6.7 年的随访中,10 位痊愈患者中有 9 位保持了缓解。一名复发患者成功接受了再次手术。5 名初治联合缓解失败的患者中有 3 人接受了再治疗,其中 2 人获得了联合缓解,1 人失败。一名患者因生活质量良好而拒绝任何后续治疗。最后一名患者在 1 年的随访中出现延迟愈合。在最后一次随访中,抢救治疗后的总体成功率达到86.6%。在所有随访期间,安全性都得到了保证:结论:这是已发表的随访时间最长的 MFat 注射治疗 PCD 试验。我们的研究结果表明,在最初 24 周内获得治愈的患者在长期评估时仍能保持应答。此外,对于无应答的患者,重复治疗作为抢救疗法也是有道理的。
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来源期刊
Inflammatory Bowel Diseases
Inflammatory Bowel Diseases 医学-胃肠肝病学
CiteScore
9.70
自引率
6.10%
发文量
462
审稿时长
1 months
期刊介绍: Inflammatory Bowel Diseases® supports the mission of the Crohn''s & Colitis Foundation by bringing the most impactful and cutting edge clinical topics and research findings related to inflammatory bowel diseases to clinicians and researchers working in IBD and related fields. The Journal is committed to publishing on innovative topics that influence the future of clinical care, treatment, and research.
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