{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:18:50Z","timestamp":1792793930570,"version":"4.5.0"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,1,4]],"date-time":"2025-01-04T00:00:00Z","timestamp":1735948800000},"content-version":"vor","delay-in-days":3,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Janssen and St Vincent\u2019s Hospital Melbourne","id":[{"id":"https:\/\/ror.org\/001kjn539","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,1,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Crohn\u2019s perianal fistula healing rates remain low. We evaluated the efficacy of a protocolized multidisciplinary treatment strategy optimizing care in adults with Crohn\u2019s perianal fistulas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A new treatment strategy was established at a single tertiary center. The strategy comprised 3 dynamic stages of care directed toward achieving and maintaining fistula healing. Stage A, active disease, focused on early commencement and proactive escalation of biologic therapies and structured surgical reviews ensuring adequate fistula drainage and conditioning. Stage B, optimized disease with a seton in situ, focused on consideration for seton removal and appropriateness of definitive surgical closure and\/or ablative techniques. Stage C, healed disease, focused on proactive care maintenance. Sixty patients were sequentially enrolled and prospectively followed for \u226512 months. Endpoints included clinical healing and radiologic remission in those with clinically active fistulas, and relapse in those with healed fistulas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At baseline, 52% (n\u2005=\u200531) and 48% (n\u2005=\u200529) had clinically active and healed fistulas, respectively. For patients with clinically active fistulas, 71% achieved clinical healing after 22 months, with estimated healing rates of 39% and 84% at 1 and 2 years, respectively. Radiologic remission was achieved in 25%, significantly higher than baseline inclusion rates of 6%. For patients with healed fistulas, 7% experienced clinical relapse after 23 months, with no significant change in radiologic remission, 80% versus 86% at baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A protocolized treatment strategy proactively optimizing care resulted in high rates of clinical healing and improved radiologic remission of Crohn\u2019s perianal fistulas. Controlled-matched studies are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjae199","type":"journal-article","created":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T07:17:55Z","timestamp":1735802275000},"source":"Crossref","is-referenced-by-count":7,"title":["A new protocolized treatment strategy optimizing medical and surgical care leads to improved healing of Crohn\u2019s perianal fistulas"],"prefix":"10.1093","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9325-9876","authenticated-orcid":false,"given":"Michael","family":"De Gregorio","sequence":"first","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leon S","family":"Winata","sequence":"additional","affiliation":[{"name":"Department of Medical Imaging, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Imogen","family":"Hartley","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Corina C","family":"Behrenbruch","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Colorectal Surgery, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5606-0270","authenticated-orcid":false,"given":"Susan J","family":"Connor","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Liverpool Hospital Sydney , Liverpool, New South Wales ,\u00a0","place":["Australia"]},{"name":"Department of UNSW Medicine & Health, UNSW Sydney, South West Sydney Clinical Campuses , Sydney, New South Wales ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"D\u2018Souza","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Colorectal Surgery, Northern Hospital , Epping, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6103-769X","authenticated-orcid":false,"given":"Chamara","family":"Basnayake","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glen R","family":"Guerra","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Surgery, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J","family":"Johnston","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3319-7199","authenticated-orcid":false,"given":"Michael A","family":"Kamm","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James O","family":"Keck","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Lust","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Niewiadomski","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugene J S","family":"Ong","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0257-6535","authenticated-orcid":false,"given":"Julien D","family":"Schulberg","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5952-1570","authenticated-orcid":false,"given":"Ashish","family":"Srinivasan","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Gastroenterology, Austin Health , Heidelberg, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Gastroenterology, Eastern Health , Box Hill, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom","family":"Sutherland","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medical Imaging, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney J","family":"Woods","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3896-7826","authenticated-orcid":false,"given":"Emily K","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William R","family":"Connell","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander J","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nik S","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, St Vincent\u2019s Hospital Melbourne , Fitzroy, Victoria ,\u00a0","place":["Australia"]},{"name":"Department of Medicine, University of Melbourne , Melbourne, Victoria ,\u00a0","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,1,4]]},"reference":[{"key":"2025012807112382300_CIT0001","doi-asserted-by":"crossref","first-page":"4821","DOI":"10.3748\/wjg.v24.i42.4821","article-title":"Burden and outcomes for complex perianal fistulas in Crohn\u2019s disease: systematic review","volume":"24","author":"Panes","year":"2018","journal-title":"World J Gastroenterol."},{"key":"2025012807112382300_CIT0002","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1053\/gast.2002.32362","article-title":"The natural history of fistulizing Crohn\u2019s disease in Olmsted County, Minnesota","volume":"122","author":"Schwartz","year":"2002","journal-title":"Gastroenterology."},{"key":"2025012807112382300_CIT0003","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1056\/NEJM199905063401804","article-title":"Infliximab for treatment of fistulas in patients with Crohn\u2019s 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Canadian Crohn\u2019s Relapse Prevention Trial Study Group","volume":"106","author":"Irvine","year":"1994","journal-title":"Gastroenterology."},{"key":"2025012807112382300_CIT0016","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1348\/014466505X29657","article-title":"The short-form version of the Depression Anxiety Stress Scales (DASS-21): construct validity and normative data in a large non-clinical sample","volume":"44","author":"Henry","year":"2005","journal-title":"Br J Clin Psychol."},{"key":"2025012807112382300_CIT0017","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s13244-017-0579-9","article-title":"Role of magnetic resonance imaging in the management of perianal Crohn\u2019s disease","volume":"9","author":"Gallego","year":"2018","journal-title":"Insights Imaging."},{"key":"2025012807112382300_CIT0018","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1136\/gut.36.3.407","article-title":"Pelvic and perineal complications of Crohn\u2019s disease: assessment using magnetic resonance imaging","volume":"36","author":"Haggett","year":"1995","journal-title":"Gut."},{"key":"2025012807112382300_CIT0019","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.14309\/ajg.0000000000000810","article-title":"Ustekinumab for perianal Crohn\u2019s disease: the BioLAP Multicenter Study from the GETAID","volume":"115","author":"Chapuis-Biron","year":"2020","journal-title":"Am J Gastroenterol."},{"key":"2025012807112382300_CIT0020","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1111\/apt.15665","article-title":"Vedolizumab for perianal Crohn\u2019s disease: a multicentre cohort study in 151 patients","volume":"51","author":"Chapuis-Biron","year":"2020","journal-title":"Aliment Pharmacol Ther."},{"key":"2025012807112382300_CIT0021","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1136\/gut.2008.159251","article-title":"Adalimumab for the treatment of fistulas in patients with Crohn\u2019s disease","volume":"58","author":"Colombel","year":"2009","journal-title":"Gut."},{"key":"2025012807112382300_CIT0022","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1002\/ibd.21940","article-title":"Long-term MRI-guided combined anti-TNF-\u03b1 and thiopurine therapy for Crohn\u2019s perianal fistulas","volume":"18","author":"Tozer","year":"2012","journal-title":"Inflamm Bowel Dis."},{"key":"2025012807112382300_CIT0023","doi-asserted-by":"crossref","first-page":"S414","DOI":"10.1093\/ecco-jcc\/jjz203.598","article-title":"P469 Stay in class or switch out of class after anti-TNF failure in inflammatory bowel disease (IBD). 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