{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:25:31Z","timestamp":1791516331125,"version":"4.3.4"},"reference-count":47,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Aliment Pharmacol Ther"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aims<\/jats:title>\n                    <jats:p>Perianal fistulising Crohn's disease (pfCD) is a heterogeneous phenotype of Crohn's disease with marked variability in anatomical complexity, symptomatology, and disease trajectory. This often creates uncertainty in the optimal approach to management, particularly the surgical aspects of when to perform examination under anaesthesia (EUA) and when to insert or remove setons.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a systematic review following PRISMA guidelines. Multiple databases were searched from inception through December 2025. Eligible publications included clinical guidelines on pfCD and\/or rectovaginal fistulas that reported indications for EUA, seton insertion, and\/or seton removal. We stratified recommendations by fistula complexity, the presence of abscesses, and clinical symptoms. Risk of bias was assessed using the AGREE II Instrument.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty\u2010four guidelines met inclusion criteria. EUA (and often seton placement) was universally recommended for perianal abscesses and frequently for symptomatic complex pfCD. For asymptomatic complex or symptomatic simple fistulas, recommendations were variable and often conditional on the presence of proctitis or plans for biologic therapy. In contrast, EUA and setons were not broadly endorsed for asymptomatic simple fistulas. Recommendations for seton removal varied widely, ranging from predefined intervals after anti\u2010TNF therapy initiation to individualised criteria based on clinical or radiologic response. Most guidelines did not consider symptom type\/severity, prior surgery, suitability for surgical closure, and asymptomatic abscesses detected by imaging.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Substantial heterogeneity and limitations exist across guidelines on the surgical management of pfCD. This underscores the need for international consensus informed by multidisciplinary expertise to standardise care in this complex population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apt.70569","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:02:16Z","timestamp":1771228936000},"page":"932-944","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Systematic Review of Published Guidelines: Recommendations for Exams Under Anaesthesia, Seton Insertion and Timing of Seton Removal for Perianal and Rectovaginal Fistulising Crohn's Disease"],"prefix":"10.1111","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0688-4869","authenticated-orcid":false,"given":"Edgard","family":"Medawar","sequence":"first","affiliation":[{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hritvic","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amine","family":"Zoughlami","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology McGill University Health Centre  Montreal Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malik","family":"Ekhdoura","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Widad","family":"Safih","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Sherbrooke  Sherbrooke Quebec Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5568-5148","authenticated-orcid":false,"given":"Shyla","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Medicine University of Ottawa  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serre\u2010Yu","family":"Wong","sequence":"additional","affiliation":[{"name":"The Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parakkal","family":"Deepak","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology Washington University School of Medicine in St. Louis  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ailsa","family":"Hart","sequence":"additional","affiliation":[{"name":"St Mark's Hospital, Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phil","family":"Tozer","sequence":"additional","affiliation":[{"name":"St Mark's Hospital, Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D.","family":"McCurdy","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Gastroenterology and Hepatology University of Ottawa  Ottawa Ontario Canada"},{"name":"The Ottawa Hospital Research Institute  Ottawa Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izab287"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468-1253(22)00007-3"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2024.06.047"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12955-020-01622-7"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3182099d9e"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10620-023-08096-9"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/ibd\/izy247"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjae089"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2021.04.023"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-306709"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjad185"},{"issue":"5","key":"e_1_2_11_13_1","first-page":"1503","article-title":"American Gastroenterological Association Medical Position Statement: Perianal Crohn's Disease","volume":"125","year":"2003","journal-title":"Gastroenterology"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2018.11.030"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.090449"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2025.02.009"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2025.11.005"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2024-334395"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1055\/a-2309-6123"},{"key":"e_1_2_11_21_1","volume-title":"Diagnostik og Behandling af fistler ved Crohns sygdom. 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