Published online Jun 28, 2021. doi: 10.3748/wjg.v27.i24.3643
Peer-review started: January 9, 2021
First decision: January 23, 2021
Revised: March 10, 2021
Accepted: June 4, 2021
Article in press: June 4, 2021
Published online: June 28, 2021
Despite significant progress in medical therapy and surgical options, definite surgery for complex anal fistula in Crohn’s disease remains challenging.
At present, failure rates after surgery for complex anal fistula associated with Crohn’s disease are still high, and surgical options in patients with recurrent and/or multi-tract fistula are limited.
The primary objective was to assess whether local stem cell injection is associated with acceptable healing rates in a routine clinical setting.
Providing strict inclusion and exclusion criteria, 12 patients with complex anal fistulas associated with Crohn’s disease underwent local application of allogenic, adipose-derived mesenchymal stem cells (darvadstrocel). Darvadstrocel was only indicated in patients without active Crohn’s disease confirmed by ileocolonoscopy and without presence of anorectal abscess. Study design was retrospective and routine clinical data were analyzed.
Twelve patients (6 females, 6 males) with complex anal fistula associated with Crohn’s disease underwent fistula curettage, transanal closure of internal openings and local darvadstrocel administration. Fifty-eight percent of patients had two complex fistulas, and seventy-six percent of the fistulas were transsphincteric. After a mean follow-up of 14.3 mo, a healing rate of 66.7% (8/12) was documented. Perianal abscess occurred in 33.3% of patients during follow-up.
This single-center experience demonstrates that local stem cell injection for complex perianal fistulizing disease is safe and provides acceptable healing rates. However, conclusions are limited due to the small number of patients and the retrospective study design.
Based on the current results, local stem cell injection could be a new “puzzle piece” for effective treatment of complex anal fistulas associated with Crohn’s disease.