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Fathallah N, Akaffou M, Haouari MA, Spindler L, Alam A, Barré A, Pommaret E, Fels A, de Parades V. Deep remission improves the quality of life of patients with Crohn's disease and anoperineal fistula treated with darvadstrocel: results of a French pilot study. Tech Coloproctol 2023; 27:1201-1210. [PMID: 36811811 DOI: 10.1007/s10151-023-02765-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 01/31/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND The injection of allogeneic adipose tissue-derived mesenchymal stem cells (MSC) into anal fistulas in patients with Crohn's disease has never been evaluated in "real-life" conditions in France. METHODS We prospectively studied the first patients receiving MSC injections at our center and undergoing 12 months of follow-up. The primary endpoint was the clinical and radiological response rate. The secondary endpoints were symptomatic efficacy, safety, anal continence, quality of life (Crohn's anal fistula-quality of life scale, CAF-QoL), and predictive factors of success. RESULTS We included 27 consecutive patients. The complete clinical and radiological response rates at M12 were 51.9% and 50%, respectively. The combined complete clinical-radiological response (deep remission) rate was 34.6%. No major adverse effects or changes in anal continence were reported. The perianal disease activity index decreased from 6.4 to 1.6 (p < 0.001) for all patients. The CAF-QoL score also decreased from 54.0 to 25.5 (p < 0.001). At the end of the study, M12, the CAF-QoL score was significantly lower only in patients with a complete combined clinical-radiological response relative to those without a complete clinical-radiological response (15.0 versus 32.8, p = 0.01). Having a multibranching fistula and infliximab treatment were associated with a combined complete clinical-radiological response. CONCLUSIONS This study confirms reported efficacy data for the injection of MSC for complex anal fistulas in Crohn's disease. It also shows a positive impact on the quality of life of patients, particularly those for whom a combined clinical-radiological response was achieved.
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Affiliation(s)
- N Fathallah
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France.
| | - M Akaffou
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - M A Haouari
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - L Spindler
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Alam
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Barré
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - E Pommaret
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - A Fels
- Clinical Research Centre, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - V de Parades
- Department of MedicoSurgical Proctology, Institut Léopold Bellan, Groupe Hospitalier Paris Saint-Joseph, Paris, France
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Haouari MA, Touloupas C, Boulay-Coletta I, Fathallah N, Spindler L, de Parades V, Zins M. [The rôle of MRI in exploration anorectal pathologies]. Rev Prat 2023; 73:1113-1118. [PMID: 38294482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
PLACE DE L'IRM POUR EXPLORER LES PATHOLOGIES ANORECTALES. L'imagerie par résonance magnétique (IRM) est l'un des examens d'imagerie les plus utiles à l'exploration des pathologies ano rectales. Elle est complémentaire de l'examen clinique et de l'endo scopie. Elle permet de fournir des données indispensables à une prise en charge optimale du patient par le proctologue, le chirurgien ou l'oncologue en fonction de la nature de l'atteinte anale ou rectale. Il est nécessaire de respecter les différentes indications de cet examen, qui ont été bien définies pour chaque pathologie par les différentes sociétés savantes. Le protocole de l'IRM varie en fonction de la zone explorée et de la pathologie suspectée. C'est pourquoi il est indispensable de fournir au radiologue les informations nécessaires telles que la suspicion diagnostique, les données cliniques, ainsi que les résultats des examens complémentaires déjà réalisés. Les indications les plus fréquentes de l'IRM en proctologie sont les tumeurs anales et rectales. L'IRM permet le bilan initial de l'extension locorégionale de la tumeur ainsi que le suivi oncologique précoce et tardif grâce à l'étude comparative des examens de surveillance par rapport au bilan initial. L'IRM est indispensable pour l'exploration des suppurations anopérinéales complexes, en particulier liées à la maladie de Crohn. Elle permet la réalisation du bilan lésionnel initial ainsi que le contrôle post-drainage. En cas de suspicion de maladie de Verneuil ou de sinus pilonidal infecté, l'IRM participe à l'orientation vers le diagnostic étiologique. La déféco-IRM est une variante particulière de l'IRM pelvienne et périnéale. Elle fait partie du bilan des dysfonctions du plancher pelvien, car elle permet l'étude du comportement des différents organes pelviens au cours des efforts de poussée et de défécation. Les fissures anales et les thromboses hémorroïdaires sont les causes les plus fréquentes de douleurs anales. Leur diagnostic est purement clinique. En cas d'examen proctologique normal, l'IRM sert à chercher une autre cause à ces douleurs.
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Affiliation(s)
| | | | | | - Nadia Fathallah
- Service de proctologie, hôpital Paris-Saint-Joseph, Paris, France
| | - Lucas Spindler
- Service de proctologie, hôpital Paris-Saint-Joseph, Paris, France
| | | | - Marc Zins
- Service d'imagerie, hôpital Paris-Saint-Joseph, Paris, France
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Fathallah N, Siproudhis L, Akaffou M, Haouari MA, Landemaine A, Pommaret E, Spindler L, Brochard C, Bouguen G, de Parades V. Allogenic stem cells for Crohn's anal fistulas: Treating early improves the deep remission rate. Colorectal Dis 2023; 25:2170-2176. [PMID: 37849054 DOI: 10.1111/codi.16782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 07/08/2023] [Accepted: 08/03/2023] [Indexed: 10/19/2023]
Abstract
AIM The aim of this study was to evaluate the real-life clinical and radiological efficacy of darvadstrocel injection into complex perianal fistulas in Crohn's disease. Secondary endpoints were to assess symptomatic efficacy, adverse effects and factors associated with complete combined clinical-radiological response (deep remission). METHODS After marketing the product in France, all first patients treated consecutively were included. A complete clinical response was defined by a complete closure of all external openings with no discharge on pressure. A complete radiological response (MRI), evaluated at least after six months of follow-up, was defined by a completely fibrotic sequela without abscess. A deep remission was defined as the association of a complete clinical response with a complete radiological response. RESULTS A total of 43 patients were included (M/F: 22/21, median age 37 [26-45] years). The fistulas were already drained with seton(s) and were on biologic treatment. After a median follow-up of 383 (359-505) days, 28 (65%) patients showed a clinical response (22 complete and 6 partial) and 16 (37%) achieved a deep remission. The Perineal Disease Activity Index decreased significantly after treatment: 39 (91%) patients reported symptomatic improvement in terms of discharge, pain, and induration, and 28 (65%) no longer had any perineal symptoms. No severe adverse events were reported. A short history of Crohn's disease <3 years was significantly associated with deep remission (OD 4.5 [1.0-19.1], p = 0.04). CONCLUSION Darvadstrocel injection resulted in a clinical response for two thirds of patients and deep remission for one third. A shorter duration of Crohn's disease was associated with deep remission.
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Affiliation(s)
- Nadia Fathallah
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Laurent Siproudhis
- Gastroenterology, CHU-Ponchaillou, Rennes, France
- University Rennes 1, Rennes, France
| | - Mélissa Akaffou
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | - Amandine Landemaine
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Elise Pommaret
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Lucas Spindler
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Charlène Brochard
- Gastroenterology, CHU-Ponchaillou, Rennes, France
- University Rennes 1, Rennes, France
- Physiology Unit, CHU-Ponchaillou, Rennes, France
| | - Guillaume Bouguen
- Gastroenterology, CHU-Ponchaillou, Rennes, France
- University Rennes 1, Rennes, France
| | - Vincent de Parades
- Department of Medicosurgical Proctology, Groupe Hospitalier Paris Saint Joseph, Paris, France
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De Parades V, Haouari MA, Fathallah N, Spindler L, Barré A, Pommaret E, Benfredj P. [Anal fistulas: Sparing the sphincter]. Rev Prat 2023; 73:274-278. [PMID: 37289115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
ANAL FISTULAS SPARING THE SPHINCTER. Fistulotomy is the most used treatment for anal fistula. It is very effective with a cure rate of over 95% but carries a risk of incontinence. This has led to the development of various sphincter sparing techniques. The injection of biological glue or paste and the insertion of a plug have disappointing results and are expensive. The rectal advancement flap is still practised because of its cure rate of around 75% but it may result in some incontinence. Intersphincteric ligation of the fistula track and laser treatment are widely practised in France with cure rates between 60 and 70%. Video-assisted anal fistula treatment as well as injections of adipose tissue, stromal vascular fraction, platelet-enriched plasma and/or mesenchymal stem cells are emerging techniques for which even better results are expected.
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Affiliation(s)
- Vincent De Parades
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | | | - Nadia Fathallah
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Lucas Spindler
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Amélie Barré
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Elise Pommaret
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
| | - Paul Benfredj
- Service de proctologie médico-chirurgicale, groupe hospitalier Paris Saint-Joseph, Paris, France
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Haouari MA, Boulay-Coletta I, Khatri G, Touloupas C, Anglaret S, Tardivel AM, Beranger-Gibert S, Silvera S, Loriau J, Zins M. Complications of Mesh Sacrocolpopexy and Rectopexy: Imaging Review. Radiographics 2023; 43:e220137. [PMID: 36701247 DOI: 10.1148/rg.220137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Sacrocolpopexy and rectopexy are commonly used surgical options for treatment of patients with pelvic organ and rectal prolapse, respectively. These procedures involve surgical fixation of the vaginal vault or the rectum to the sacral promontory with mesh material and can be performed independently of each other or in a combined fashion and by using an open abdominal approach or laparoscopy with or without robotic assistance. Radiologists can be particularly helpful in cases where patients' surgical histories are unclear by identifying normal sacrocolpopexy or rectopexy mesh material and any associated complications. Acute complications such as bleeding or urinary tract injury or stricture are generally evaluated with CT. More chronic complications such as mesh extrusion or exposure with or without fistulization to surrounding structures are generally evaluated with MRI. Other complications can have a variable time of onset after surgery. Patients with suspected bowel obstruction are generally evaluated with CT. Those with suspected infection, abscess formation, and discitis or osteomyelitis may be evaluated with MRI, although CT evaluation may be appropriate in certain scenarios. The authors review the sacrocolpopexy and rectopexy surgical techniques, discuss appropriate imaging protocols for evaluation of patients with suspected complications, and illustrate the normal appearance and common complications of these procedures. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Mohamed Amine Haouari
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Isabelle Boulay-Coletta
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Gaurav Khatri
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Caroline Touloupas
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Sophie Anglaret
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Anne-Marie Tardivel
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Sophie Beranger-Gibert
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Stephane Silvera
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Jerome Loriau
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
| | - Marc Zins
- From the Departments of Radiology (M.A.H., I.B.C., C.T., S.A., A.M.T., S.B.G., S.S., M.Z.) and Digestive Surgery (J.L.), Groupe Hospitalier Paris Saint-Joseph, 185 Rue Raymond Losserand, 74014 Paris, France; and Department of Radiology, University of Texas Southwestern Medical Center, Dallas, Tex (G.K.)
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