{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T16:24:25Z","timestamp":1790180665405,"version":"4.1.0"},"reference-count":47,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T00:00:00Z","timestamp":1637193600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Management of perianal fistulas differs based on fistula type. We aimed to assess the ability of diagnostic strategies to differentiate between Crohn\u2019s disease (CD) and cryptoglandular disease (CGD) in patients with perianal fistulas.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a diagnostic accuracy systematic review and meta-analysis. A systematic search of electronic databases was performed from inception through February 2021 for studies assessing a diagnostic test\u2019s ability to distinguish fistula types. We calculated weighted summary estimates with 95% confidence intervals for sensitivity and specificity by bivariate analysis, using fixed effects models when data were available from 2 or more studies. The Quality Assessment of Diagnostic Accuracy Studies tool was used to assess study quality.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Twenty-one studies were identified and included clinical symptoms (2 studies; n=154), magnetic resonance imaging (MRI) characteristics (3 studies; n=296), ultrasound characteristics (7 studies; n=1003), video capsule endoscopy (2 studies; n=44), fecal calprotectin (1 study; n=56), and various biomarkers (8 studies; n=440). MRI and ultrasound characteristics had the most robust data. Rectal inflammation, multiple-branched fistula tracts, and abscesses on pelvic MRI and the Crohn\u2019s ultrasound fistula sign, fistula debris, and bifurcated fistulas on pelvic ultrasonography had high specificity (range, 80%-95% vs 89%-96%) but poor sensitivity (range, 17%-37% vs 31%-63%), respectively. Fourteen of 21 studies had risk of bias on at least 1 of the Quality Assessment of Diagnostic Accuracy Studies domains.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Limited high-quality evidence suggest that imaging characteristics may help discriminate CD from CGD in patients with perianal fistulas. Larger, prospective studies are needed to confirm these findings and to evaluate if combining multiple diagnostic tests can improve diagnostic sensitivity.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ibd\/izab286","type":"journal-article","created":{"date-parts":[[2021,11,18]],"date-time":"2021-11-18T13:38:30Z","timestamp":1637242710000},"page":"1363-1374","source":"Crossref","is-referenced-by-count":31,"title":["Strategies to Distinguish Perianal Fistulas Related to Crohn\u2019s Disease From Cryptoglandular Disease: Systematic Review With Meta-Analysis"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4876-212X","authenticated-orcid":false,"given":"Kevin","family":"Chin Koon Siw","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jake","family":"Engel","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ottawa , ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha","family":"Visva","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Ottawa , ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjeeta","family":"Mallick","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ailsa","family":"Hart","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, St Mark\u2019s Hospital , London , United Kingdom and the"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"de Buck van Overstraeten","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mount Sinai Hospital, University of Toronto , Toronto, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D","family":"McCurdy","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, University of Ottawa , Ottawa, ON , Canada"},{"name":"Ottawa Hospital Research Institute , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,11,18]]},"reference":[{"key":"2023112019094375800_CIT0001","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.3748\/wjg.v21.i5.1394","article-title":"Management of perianal fistulas in Crohn\u2019s disease: an up-to-date review.","volume":"21","author":"Marzo","year":"2015","journal-title":"World J Gastroenterol."},{"key":"2023112019094375800_CIT0002","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00384-007-0334-7","article-title":"An assessment of the incidence of fistula-in-ano in four countries of the European Union.","volume":"22","author":"Zanotti","year":"2007","journal-title":"Int J Colorectal Dis."},{"key":"2023112019094375800_CIT0003","doi-asserted-by":"crossref","first-page":"0300060520986669","DOI":"10.1177\/0300060520986669","article-title":"Current concepts in the pathogenesis of cryptoglandular perianal fistula.","volume":"49","author":"W\u0142odarczyk","year":"2021","journal-title":"J Int Med Res."},{"key":"2023112019094375800_CIT0004","first-page":"219","article-title":"Fistula-in-ano in a defined population. 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fistula: the role of ultrasonography in differential diagnosis.","volume":"2","author":"Dias De Castro","year":"2014","journal-title":"United European Gastroenterol J."},{"key":"2023112019094375800_CIT0032","first-page":"43","article-title":"A new endoanal ultrasound SGN associated with perianal Crohn\u2019s disease. Description and accuracy analysis.","volume":"19","author":"Garcia-Cabrera","year":"2019","journal-title":"Colorectal Dis."},{"key":"2023112019094375800_CIT0033","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1111\/codi.12204","article-title":"Transperineal ultrasonography in perianal Crohn\u2019s disease and recurrent cryptogenic fistula-in-ano.","volume":"15","author":"Nevler","year":"2013","journal-title":"Colorectal Dis."},{"key":"2023112019094375800_CIT0034","doi-asserted-by":"crossref","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 (NY)."},{"key":"2023112019094375800_CIT0035","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1177\/2050640619834464","article-title":"Diagnostic accuracy of faecal calprotectin in patients with active perianal 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