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Senéjoux A, Siproudhis L, Abramowitz L, Munoz-Bongrand N, Desseaux K, Bouguen G, Bourreille A, Dewit O, Stefanescu C, Vernier G, Louis E, Grimaud JC, Godart B, Savoye G, Hebuterne X, Bauer P, Nachury M, Laharie D, Chevret S, Bouhnik Y. Fistula Plug in Fistulising Ano-Perineal Crohn's Disease: a Randomised Controlled Trial. J Crohns Colitis 2016; 10:141-8. [PMID: 26351393 DOI: 10.1093/ecco-jcc/jjv162] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Accepted: 07/26/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Anal fistula plug [AFP] is a bioabsorbable bioprosthesis used in ano-perineal fistula treatment. We aimed to assess efficacy and safety of AFP in fistulising ano-perineal Crohn's disease [FAP-CD]. METHODS In a multicentre, open-label, randomised controlled trial we compared seton removal alone [control group] with AFP insertion [AFP group] in 106 Crohn's disease patients with non- or mildly active disease having at least one ano-perineal fistula tract drained for more than 1 month. Patients with abscess [collection ≥ 3mm on magnetic resonance imaging or recto-vaginal fistulas were excluded. Randomisation was stratified in simple or complex fistulas according to AGA classification. Primary end point was fistula closure at Week 12. RESULTS In all, 54 patients were randomised to AFP group [control group 52]. Median fistula duration was 23 [10-53] months. Median Crohn's Disease Activity Index at baseline was 81 [45-135]. Fistula closure at Week 12 was achieved in 31.5% patients in the AFP group and in 23.1 % in the control group (relative risk [RR] stratified on AGA classification: 1.31; 95% confidence interval: 0.59-4.02; p = 0.19). No interaction in treatment effect with complexity stratum was found; 33.3% of patients with complex fistula and 30.8% of patients with simple fistula closed the tracts after AFP, as compared with 15.4% and 25.6% in controls, respectively [RR of success = 2.17 in complex fistula vs RR = 1.20 in simple fistula; p = 0.45]. Concerning safety, at Week 12, 17 patients developed at least one adverse event in the AFP group vs 8 in the controls [p = 0.07]. CONCLUSION AFP is not more effective than seton removal alone to achieve FAP-CD closure.
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Affiliation(s)
- A Senéjoux
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
| | - L Siproudhis
- Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - L Abramowitz
- Hôpital Bichat, Université Diderot Paris 7, Paris, France
| | | | - K Desseaux
- Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Université Diderot Paris 7, Paris, France
| | - G Bouguen
- Hôpital Pontchaillou, Université Rennes 1, Rennes, France
| | - A Bourreille
- Institut des Maladies de l'Appareil Digestif, CHU Nantes, Nantes, France
| | - O Dewit
- Clinique Universitaire Saint Luc, Bruxelles, Belgique
| | - C Stefanescu
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
| | - G Vernier
- Hôpital Claude Huriez, Université Lille 2, Lille, France
| | - E Louis
- CHU Sart Tilman, Université de Liège, Liège, Belgique
| | - J C Grimaud
- Hôpital Nord, Centre d'investigation Clinique Marseille Nord, Université Méditerranée, Marseille, France
| | | | - G Savoye
- Hôpital Charles Nicolle, Université de Rouen UR, Rouen, Franc
| | - X Hebuterne
- Hôpital de l'Archet, Université Nice Sophia-Antipolis, Nice, France
| | - P Bauer
- GH Diaconesses-Croix Saint-Simon, Paris, France
| | - M Nachury
- Hôpital Jean Minjoz, Université de Franche-Comté, Besançon, France
| | - D Laharie
- Hôpital Sud, Université Bordeaux Segalen, Bordeaux, France
| | - S Chevret
- Biostatistics and Clinical Epidemiology, Hôpital Saint-Louis, Université Diderot Paris 7, Paris, France
| | - Y Bouhnik
- Gastroentérologie, MICI et Assistance Nutritive, Hôpital Beaujon - APHP, Clichy, France
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Joscht M, Martin M, Henin M, Nisolle JF, Kirschvink N, Dugdale A, Godart B, Coulon H, Simon V, Hontoir F, Graffin R, De Raeve Y, Vandeweerd JM. Angiographic Anatomy of External Iliac Arteries in the Sheep. Anat Histol Embryol 2015; 45:443-449. [DOI: 10.1111/ahe.12218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 10/07/2015] [Indexed: 11/28/2022]
Affiliation(s)
- M. Joscht
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - M. Martin
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - M. Henin
- Centre Hospitalier Universitaire (CHU) de Mont Godinne; Université Catholique de Louvain; Rue Dr. G. Therasse 1, 5530; Yvoir Belgium
| | - J. F. Nisolle
- Centre Hospitalier Universitaire (CHU) de Mont Godinne; Université Catholique de Louvain; Rue Dr. G. Therasse 1, 5530; Yvoir Belgium
| | - N. Kirschvink
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - A. Dugdale
- Faculty of Health and Life Sciences; University of Liverpool; Leahurst Campus CH647TE Neston UK
| | - B. Godart
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - H. Coulon
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - V. Simon
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - F. Hontoir
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - R. Graffin
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - Y. De Raeve
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
| | - J. M. Vandeweerd
- Department of Veterinary Medicine; Integrated Veterinary Research Unit - Namur Research Institute for Life Sciences (IVRU-NARILIS); University of Namur; Namur Belgium
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Gautier M, Godeberge P, Ganansia R, Bozio G, Godart B, Bigard MA, Barthet M, Siproudhis L. Easy clip to treat anal fistula tracts: a word of caution. Int J Colorectal Dis 2015; 30:621-4. [PMID: 25675886 DOI: 10.1007/s00384-015-2146-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIMS Closing the internal opening by a clip ovesco has been recently proposed for healing the fistula tract, but, to date, data on benefit are poorly analyzed. The aim was to report a preliminary multicenter experience. MATERIALS AND METHODS Retrospective study was undertaken in six different French centers: surgical procedure, immediate complications, and follow-up have been collected. RESULTS Nineteen clips were inserted in 17 patients (M/F, 4/13; median age, 42 years [29-54]) who had an anal fistula: 12 (71%) high fistulas (including 4 rectovaginal fistulas), 5 (29%) lower fistulas (with 3 rectovaginal fistulas), and 6 (35%) Crohn's fistulas. Out of 17 patients, 15 had a seton drainage beforehand. The procedure was easy in 8 (47%) patients and the median operative time was 27.5 min (20-36.5). Postoperative period was painful for 11 (65%) patients. A clip migration was noted in 11 patients (65%) after a median follow-up of 10 days (5.5-49.8). Eleven patients (65%) who failed had reoperation including 10 new drainages within the first month (0.5-5). After a mean follow-up of 4 months (2-7),, closing the tract was observed in 2 patients (12%) following the first insertion of the clip and in another one after a second insertion. CONCLUSION Treatment of anal fistula by placing a clip on the internal opening is disappointing and deleterious for some patients. A better assessment before dissemination is recommended.
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