{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T13:03:09Z","timestamp":1789218189214,"version":"build-2803163510"},"reference-count":15,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T00:00:00Z","timestamp":1732665600000},"content-version":"vor","delay-in-days":57,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Isolated complex perianal fistulas, without luminal evidence of inflammatory bowel disease in the gastrointestinal tract, pose diagnostic and treatment dilemmas for gastroenterologists and colorectal surgeons. For patients who develop recurrent complex fistulas, a presumptive diagnosis of Crohn\u2019s disease may be made. It is unclear whether these cases of isolated perianal disease in the absence of luminal inflammation truly represent isolated severe cryptoglandular fistulas or rather an early presentation of Crohn\u2019s disease. We aimed to investigate the clinical course and outcomes of patients with isolated complex perianal fistulas.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In this retrospective multicenter case series across 6 institutions in the United States, we report the clinical course of patients with isolated recurrent complex perianal fistulas, including their diagnostic evaluation, medical and surgical therapies, and clinical outcomes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>All patients (n\u2005=\u200524) required incision and drainage of perirectal abscesses. The majority received setons (n\u2005=\u200519, 79%), more intensive surgical interventions (n\u2005=\u200515, 62.5%, including fistulotomy\/sphincterotomy, advancement flap, and ligation of the intersphincteric fistula tract), antibiotics (n\u2005=\u200517, 71%), and biologic therapy (n\u2005=\u200516, 67%). Nine patients (37.5%) underwent a combined medical-surgical approach with biologics and intensive surgical intervention. Despite surgical and\/or medical management, active symptomatic complex perianal fistulas persisted in 58% (n\u2005=\u200514) of patients at follow-up (median 5.5 years, interquartile range 2.5-10 years); symptom remission was achieved in 21% (n\u2005=\u20055), and fistula closure in 21% (n\u2005=\u20055).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>These cases highlight a multidisciplinary and multimodal approach when treating isolated complex perianal fistulas and their propensity to persist despite the incorporation of advanced therapies.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/crocol\/otae065","type":"journal-article","created":{"date-parts":[[2024,11,27]],"date-time":"2024-11-27T21:59:01Z","timestamp":1732744741000},"source":"Crossref","is-referenced-by-count":7,"title":["Clinical Course of Isolated Recurrent, Persistent Complex Perianal Fistulas Without Luminal Crohn\u2019s Disease: A Multicenter Case Series of 24 Patients"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8108-8101","authenticated-orcid":false,"given":"Hannah W","family":"Fiske","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, The Warren Alpert Medical School of Brown University , Providence, RI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8847-4539","authenticated-orcid":false,"given":"Chung Sang","family":"Tse","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Perelman School of Medicine at the University of Pennsylvania , Philadelphia, PA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3905-2903","authenticated-orcid":false,"given":"Badr","family":"Al-Bawardy","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Division of Gastroenterology and Hepatology, King Faisal Specialist Hospital and Research Center , Riyadh ,","place":["Saudi Arabia"]},{"name":"College of Medicine, Alfaisal University , Riyadh ,","place":["Saudi Arabia"]},{"name":"Division of Gastroenterology, Yale School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pooja","family":"Magavi","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Scripps Clinic , La Jolla, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gauree Gupta","family":"Konijeti","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Scripps Clinic , La Jolla, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Mao","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of California Davis School of Medicine , Sacramento, CA ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3993-5773","authenticated-orcid":false,"given":"Sean","family":"Fine","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, The Warren Alpert Medical School of Brown University , Providence, RI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9995-7942","authenticated-orcid":false,"given":"Alyssa","family":"Parian","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Johns Hopkins Hospital , Baltimore, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lazarev","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology & Hepatology, Johns Hopkins Hospital , Baltimore, MD ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samir A","family":"Shah","sequence":"additional","affiliation":[{"name":"Gastroenterology Associates Inc. (Powered by GI Alliance), The Warren Alpert Medical School of Brown University , Providence, RI ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,11,27]]},"reference":[{"issue":"5","key":"2024121406560989600_CIT0001","doi-asserted-by":"publisher","first-page":"1503","DOI":"10.1016\/j.gastro.2003.08.024","article-title":"American Gastroenterological Association medical position statement: perianal Crohn\u2019s disease","volume":"125","author":"American Gastroenterological Association Clinical Practice Committee","year":"2003","journal-title":"Gastroenterology."},{"issue":"2","key":"2024121406560989600_CIT0002","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1093\/ecco-jcc\/jjw169","article-title":"3rd European evidence-based consensus on the diagnosis and management of Crohn\u2019s disease 2016: Part 2: surgical management and special situations [published correction appears in J Crohns Colitis. 2022 Aug 16]","volume":"11","author":"Gionchetti","year":"2017","journal-title":"J Crohns Colitis."},{"issue":"10","key":"2024121406560989600_CIT0003","doi-asserted-by":"publisher","first-page":"1477","DOI":"10.1093\/ibd\/izab287","article-title":"Epidemiology and natural history of perianal Crohn\u2019s disease: a systematic review and meta-analysis of population-based cohorts","volume":"28","author":"Tsai","year":"2022","journal-title":"Inflamm Bowel Dis."},{"issue":"11","key":"2024121406560989600_CIT0004","doi-asserted-by":"publisher","first-page":"2022","DOI":"10.1097\/MIB.0000000000000148","article-title":"Disappointing durable remission rates in complex Crohn\u2019s disease fistula","volume":"20","author":"Molendijk","year":"2014","journal-title":"Inflamm Bowel Dis."},{"issue":"2","key":"2024121406560989600_CIT0005","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1093\/ibd\/izz051","article-title":"Refractory complex Crohn\u2019s perianal fistulas: a role for autologous microfragmented adipose tissue injection","volume":"26","author":"Laureti","year":"2020","journal-title":"Inflamm Bowel Dis."},{"issue":"12","key":"2024121406560989600_CIT0006","doi-asserted-by":"publisher","first-page":"1117","DOI":"10.1097\/DCR.0000000000000733","article-title":"Clinical practice guideline for the management of anorectal abscess, fistula-in-ano, and rectovaginal fistula","volume":"59","author":"Vogel","year":"2016","journal-title":"Dis Colon Rectum."},{"issue":"10","key":"2024121406560989600_CIT0007","doi-asserted-by":"publisher","first-page":"595","DOI":"10.1007\/s10151-015-1365-7","article-title":"Evaluation and management of perianal abscess and anal fistula: a consensus statement developed by the Italian Society of Colorectal Surgery (SICCR)","volume":"19","author":"Amato","year":"2015","journal-title":"Tech Coloproctol."},{"issue":"4","key":"2024121406560989600_CIT0008","doi-asserted-by":"publisher","first-page":"1162","DOI":"10.1007\/s00261-016-0989-z","article-title":"MRI features of perianal fistulas: is there a difference between Crohn\u2019s and non-Crohn\u2019s patients","volume":"42","author":"Oliveira","year":"2017","journal-title":"Abdom Radiol"},{"issue":"6","key":"2024121406560989600_CIT0009","doi-asserted-by":"publisher","first-page":"1784","DOI":"10.1007\/s10620-019-05905-y","article-title":"Tumor necrosis factor inhibitors may have limited efficacy for complex perianal fistulas without luminal Crohn\u2019s disease","volume":"65","author":"McCurdy","year":"2020","journal-title":"Dig Dis Sci."},{"issue":"5","key":"2024121406560989600_CIT0010","doi-asserted-by":"publisher","first-page":"185","DOI":"10.4253\/wjge.v4.i5.185","article-title":"Does capsule endoscopy have an added value in patients with perianal disease and a negative work up for Crohn\u2019s disease","volume":"4","author":"Adler","year":"2012","journal-title":"World J Gastrointest Endosc"},{"issue":"5","key":"2024121406560989600_CIT0011","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/BF02058706","article-title":"Perianal Crohn\u2019s disease. 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