{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T11:36:52Z","timestamp":1794224212308,"version":"4.8.0"},"reference-count":106,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Gut"],"accepted":{"date-parts":[[2017,12,15]]},"published-print":{"date-parts":[[2018,6]]},"abstract":"<jats:p>Perianal fistulae in patients with Crohn\u2019s disease (CD) can be associated with significant morbidity resulting in negative impact on quality of life. The last two decades have seen significant advancements in the management of perianal fistulas in CD, which has evolved into a multidisciplinary approach that includes gastroenterologists, colorectal surgeons, endoscopists and radiologists. Despite the introduction of new medical therapies such as antitumour necrosis factor and novel models of care delivery, the best fistula healing rates reported with combined medical and surgical approaches are approximately 50%. More recently, newer biologics, cell-based therapies as well as novel endoscopic and surgical techniques have been introduced raising new hopes that outcomes can be improved upon. In this review, we describe the modern management and the most recent advances in the management of complex perianal fistulising CD, which will likely impact clinical practice. We will explore optimal use of both older and newer biological agents, as well as new data on cell-based therapies. In addition, new techniques in endoscopic and surgical approaches will be discussed.<\/jats:p>","DOI":"10.1136\/gutjnl-2017-314918","type":"journal-article","created":{"date-parts":[[2018,1,13]],"date-time":"2018-01-13T12:15:26Z","timestamp":1515845726000},"page":"1181-1194","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":148,"title":["Modern management of perianal fistulas in Crohn\u2019s disease: future directions"],"prefix":"10.1136","volume":"67","clinical-trial-number":[{"clinical-trial-number":"nct02630966","registry":"10.18810\/clinical-trials-gov"},{"clinical-trial-number":"nct02630966","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9632-6691","authenticated-orcid":false,"given":"Paulo Gustavo","family":"Kotze","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Shen","sequence":"additional","affiliation":[{"name":"Interventional IBD Unit, Cleveland Clinic Foundation, Cleveland, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Lightner","sequence":"additional","affiliation":[{"name":"Division of Colorectal Surgery, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takayuki","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"IBD Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonino","family":"Spinelli","sequence":"additional","affiliation":[{"name":"Division of Colon and Rectal Surgery, Humanitas Clinical and Research Center, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subrata","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Institute of Translational Medicine, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Remo","family":"Panaccione","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Inflammatory Bowel Disease Unit, Cumming School of Medicine, University of Calgary, Calgary, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2018,1,13]]},"reference":[{"key":"2025090712452755000_67.6.1181.1","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-193811000-00007"},{"key":"2025090712452755000_67.6.1181.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04486.x"},{"key":"2025090712452755000_67.6.1181.3","doi-asserted-by":"publisher","DOI":"10.1053\/gast.2002.32362"},{"key":"2025090712452755000_67.6.1181.4","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0000000000000315"},{"key":"2025090712452755000_67.6.1181.5","doi-asserted-by":"publisher","DOI":"10.1097\/MIB.0000000000000148"},{"key":"2025090712452755000_67.6.1181.6","doi-asserted-by":"publisher","DOI":"10.1136\/gut.21.6.525"},{"key":"2025090712452755000_67.6.1181.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.gastro.2003.08.025"},{"key":"2025090712452755000_67.6.1181.8","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1097\/MIB.0000000000000378","article-title":"Guidelines for the surgical treatment of Crohn\u2019s perianal fistulas","volume":"21","author":"Fichera","year":"2015","journal-title":"Inflamm Bowel Dis"},{"key":"2025090712452755000_67.6.1181.9","doi-asserted-by":"publisher","DOI":"10.1111\/apt.12906"},{"key":"2025090712452755000_67.6.1181.10","doi-asserted-by":"publisher","DOI":"10.1097\/00054725-200303000-00003"},{"key":"2025090712452755000_67.6.1181.11","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1590\/S0004-28032014000400004","article-title":"Perianal complete remission with combined therapy (seton placement and anti-TNF agents) in Crohn\u2019s disease: a Brazilian multicenter observational study","volume":"51","author":"Kotze","year":"2014","journal-title":"Arq Gastroenterol"},{"key":"2025090712452755000_67.6.1181.12","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-007-9077-3"},{"key":"2025090712452755000_67.6.1181.13","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/codi.12851","article-title":"The results of seton drainage combined with anti-TNF\u03b1 therapy for anal fistula in Crohn\u2019s disease","volume":"17","author":"Haennig","year":"2015","journal-title":"Colorectal Dis"},{"key":"2025090712452755000_67.6.1181.14","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1111\/codi.13672","article-title":"Association of Coloproctology of Great Britain and Ireland consensus exercise on surgical management of fistulating perianal Crohn\u2019s disease","volume":"19","author":"Lee","year":"2017","journal-title":"Colorectal Dis"},{"key":"2025090712452755000_67.6.1181.15","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-011-0759-4"},{"key":"2025090712452755000_67.6.1181.16","doi-asserted-by":"crossref","first-page":"1232","DOI":"10.1111\/apt.14016","article-title":"Clinical, endoscopic and radiographic outcomes with ustekinumab in medically-refractory Crohn\u2019s disease: real world experience from a multicentre cohort","volume":"45","author":"Ma","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"2025090712452755000_67.6.1181.17","doi-asserted-by":"crossref","first-page":"E7","DOI":"10.1097\/MIB.0000000000000683","article-title":"Therapeutic armamentarium for stricturing crohn\u2019s disease: medical versus endoscopic versus surgical approaches","volume":"22","author":"Bharadwaj","year":"2016","journal-title":"Inflamm Bowel Dis"},{"key":"2025090712452755000_67.6.1181.18","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/S0140-6736(16)31203-X","article-title":"Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn\u2019s disease: a phase 3 randomised, double-blind controlled trial","volume":"388","author":"Pan\u00e9s","year":"2016","journal-title":"Lancet"},{"key":"2025090712452755000_67.6.1181.19","doi-asserted-by":"publisher","DOI":"10.1097\/SLA.0000000000000479"},{"key":"2025090712452755000_67.6.1181.20","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1007\/s10151-012-0921-7","article-title":"Video-assisted anal fistula treatment (VAAFT) combined with advancement flap repair in Crohn\u2019s disease","volume":"17","author":"Schwandner","year":"2013","journal-title":"Tech Coloproctol"},{"key":"2025090712452755000_67.6.1181.21","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjv162"},{"key":"2025090712452755000_67.6.1181.22","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-306709"},{"key":"2025090712452755000_67.6.1181.23","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1038\/nrgastro.2017.104","article-title":"Perianal fistulizing Crohn\u2019s disease: pathogenesis, diagnosis and therapy","volume":"14","author":"Pan\u00e9s","year":"2017","journal-title":"Nat Rev Gastroenterol Hepatol"},{"key":"2025090712452755000_67.6.1181.24","doi-asserted-by":"publisher","DOI":"10.1002\/ibd.20608"},{"key":"2025090712452755000_67.6.1181.25","doi-asserted-by":"publisher","DOI":"10.1136\/gutjnl-2013-304488"},{"key":"2025090712452755000_67.6.1181.26","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-123-2-199507150-00009"},{"key":"2025090712452755000_67.6.1181.27","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199905063401804"},{"key":"2025090712452755000_67.6.1181.28","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa030815"},{"key":"2025090712452755000_67.6.1181.29","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2008.159251"},{"key":"2025090712452755000_67.6.1181.30","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/MCG.0000000000000169","article-title":"Effectiveness of adalimumab in perianal fistulas in crohn\u2019s disease patients naive to anti-TNF therapy","volume":"49","author":"Casta\u00f1o-Milla","year":"2015","journal-title":"J Clin Gastroenterol"},{"key":"2025090712452755000_67.6.1181.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2010.04509.x"},{"key":"2025090712452755000_67.6.1181.32","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa0904492"},{"key":"2025090712452755000_67.6.1181.33","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1111\/codi.13311","article-title":"Treatment of perianal fistula in Crohn\u2019s disease: a systematic review and meta-analysis comparing seton drainage and anti-tumour necrosis factor treatment","volume":"18","author":"de Groof","year":"2016","journal-title":"Colorectal Dis"},{"key":"2025090712452755000_67.6.1181.34","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-015-0831-x"},{"key":"2025090712452755000_67.6.1181.35","doi-asserted-by":"publisher","DOI":"10.1093\/ecco-jcc\/jjw007"},{"key":"2025090712452755000_67.6.1181.36","first-page":"549","article-title":"Association of induction infliximab levels with clinical response in perianal crohn\u2019s disease","volume":"11","author":"Davidov","year":"2017","journal-title":"J Crohns Colitis"},{"key":"2025090712452755000_67.6.1181.37","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1111\/apt.13970","article-title":"Higher infliximab trough levels are associated with perianal fistula healing in patients with Crohn\u2019s disease","volume":"45","author":"Yarur","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"2025090712452755000_67.6.1181.38","unstructured":"Strik AS , Lowenberg M , Ponsioen CI , et al . HIgher infliximab and adalimumab serum levels correlate with perianal fistula closure in Crohn\u2019s disease. Presented at UEGW 2017. OP 183."},{"key":"2025090712452755000_67.6.1181.39","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215739"},{"key":"2025090712452755000_67.6.1181.40","doi-asserted-by":"crossref","first-page":"S396","DOI":"10.1016\/S0016-5085(17)31562-7","article-title":"Efficacy of vedolizumab in extraintestinal manifestation in patients with inflammatory bowel diseases: a post-hoc analysis of the OBSERV-IBD cohort of the GETAID","volume":"152","author":"Tadbiri","year":"2017","journal-title":"Gastroenterology"},{"key":"2025090712452755000_67.6.1181.41","unstructured":"Vedolizumab IV 300 mg in the treatment of fistulizing Crohn\u2019s disease (ENTERPRISE). NCT NCT02630966 www.clinicaltrials.gov (accessed 21 Jun 2017)."},{"key":"2025090712452755000_67.6.1181.42","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1203572"},{"key":"2025090712452755000_67.6.1181.43","doi-asserted-by":"crossref","first-page":"1946","DOI":"10.1056\/NEJMoa1602773","article-title":"Ustekinumab as induction and maintenance therapy for crohn\u2019s disease","volume":"375","author":"Feagan","year":"2016","journal-title":"N Engl J Med"},{"key":"2025090712452755000_67.6.1181.44","doi-asserted-by":"crossref","first-page":"S185","DOI":"10.1016\/S0016-5085(17)30930-7","article-title":"Fistula Healing in Pivotal Studies of Ustekinumab in Crohn\u2019s Disease. Presented at DDW 2017","volume":"152","author":"Sands","year":"2017","journal-title":"Gastroenterology"},{"key":"2025090712452755000_67.6.1181.45","doi-asserted-by":"crossref","unstructured":"Battat R , Bessissow T , Strohl M , et al . Ustekinumab for the treatment of perianal fistulas in patients with Crohn\u2019s disease. Poster presentation at the ECCO congress, Barcelona, 2017 (P626). J Crohns Colitis 2017:S400\u20131.","DOI":"10.1093\/ecco-jcc\/jjx002.750"},{"key":"2025090712452755000_67.6.1181.46","doi-asserted-by":"publisher","DOI":"10.1016\/j.cgh.2015.09.018"},{"key":"2025090712452755000_67.6.1181.47","doi-asserted-by":"crossref","first-page":"421","DOI":"10.3109\/14397595.2014.972495","article-title":"Local infliximab injection of sacroiliac joints in non-radiographic axial spondyloarthritis: Impact on clinical and magnetic resonance imaging parameters of disease activity","volume":"25","author":"Soliman","year":"2015","journal-title":"Mod Rheumatol"},{"key":"2025090712452755000_67.6.1181.48","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-004-0832-4"},{"key":"2025090712452755000_67.6.1181.49","doi-asserted-by":"crossref","first-page":"1064","DOI":"10.1080\/00365520600609941","article-title":"Treatment of perianal fistulas in Crohn\u2019s disease by local injection of antibody to TNF-alpha accounts for a favourable clinical response in selected cases: a pilot study","volume":"41","author":"Asteria","year":"2006","journal-title":"Scand J Gastroenterol"},{"key":"2025090712452755000_67.6.1181.50","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1097\/DCR.0b013e31825af532","article-title":"Effectiveness and safety of local adalimumab injection in patients with fistulizing perianal Crohn\u2019s disease: a pilot study","volume":"55","author":"Tonelli","year":"2012","journal-title":"Dis Colon Rectum"},{"key":"2025090712452755000_67.6.1181.51","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1002\/ibd.21210","article-title":"Local injection of adalimumab for perianal Crohn\u2019s disease: better than infliximab?","volume":"16","author":"Poggioli","year":"2010","journal-title":"Inflamm Bowel Dis"},{"key":"2025090712452755000_67.6.1181.52","doi-asserted-by":"crossref","unstructured":"Adegbola SO , Sahnan K , Tozer PJ , et al . Review of local injection of anti-TNF for perianal fistulising Crohn\u2019s disease. Int J Colorectal Dis 2017;32.doi:10.1007\/s00384-017-2899-0","DOI":"10.1007\/s00384-017-2899-0"},{"key":"2025090712452755000_67.6.1181.53","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-02-0586"},{"key":"2025090712452755000_67.6.1181.54","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2004-07-2921"},{"key":"2025090712452755000_67.6.1181.55","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2009-02-203943"},{"key":"2025090712452755000_67.6.1181.56","doi-asserted-by":"publisher","DOI":"10.3324\/haematol.2013.093864"},{"key":"2025090712452755000_67.6.1181.57","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0009252","article-title":"Mouse bone marrow-derived mesenchymal stromal cells turn activated macrophages into a regulatory-like profile","volume":"5","author":"Maggini","year":"2010","journal-title":"PLoS One"},{"key":"2025090712452755000_67.6.1181.58","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1186\/s13287-015-0122-1","article-title":"Ex vivo immunosuppressive effects of mesenchymal stem cells on Crohn\u2019s disease mucosal T cells are largely dependent on indoleamine 2,3-dioxygenase activity and cell-cell contact","volume":"6","author":"Ciccocioppo","year":"2015","journal-title":"Stem Cell Res Ther"},{"key":"2025090712452755000_67.6.1181.59","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2002-06-1830"},{"key":"2025090712452755000_67.6.1181.60","doi-asserted-by":"publisher","DOI":"10.3727\/096368910X557245"},{"key":"2025090712452755000_67.6.1181.61","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCRESAHA.108.186908"},{"key":"2025090712452755000_67.6.1181.62","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e3181a28533"},{"key":"2025090712452755000_67.6.1181.63","doi-asserted-by":"publisher","DOI":"10.3892\/ijmm.14.6.1035"},{"key":"2025090712452755000_67.6.1181.64","doi-asserted-by":"publisher","DOI":"10.3109\/01902148.2013.816803"},{"key":"2025090712452755000_67.6.1181.65","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-005-0052-6"},{"key":"2025090712452755000_67.6.1181.66","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181973487"},{"key":"2025090712452755000_67.6.1181.67","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e318255364a"},{"key":"2025090712452755000_67.6.1181.68","doi-asserted-by":"publisher","DOI":"10.3727\/096368912X656045"},{"key":"2025090712452755000_67.6.1181.69","doi-asserted-by":"publisher","DOI":"10.1002\/stem.1357"},{"key":"2025090712452755000_67.6.1181.70","doi-asserted-by":"publisher","DOI":"10.1136\/gut.2010.214841"},{"key":"2025090712452755000_67.6.1181.71","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1053\/j.gastro.2017.04.001","article-title":"Autologous Mesenchymal Stem Cells, Applied in a Bioabsorbable Matrix, for Treatment of Perianal Fistulas in Patients With Crohn\u2019s Disease","volume":"153","author":"Dietz","year":"2017","journal-title":"Gastroenterology"},{"key":"2025090712452755000_67.6.1181.72","doi-asserted-by":"publisher","DOI":"10.1007\/s00384-012-1581-9"},{"key":"2025090712452755000_67.6.1181.73","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2015.06.014"},{"key":"2025090712452755000_67.6.1181.74","doi-asserted-by":"publisher","DOI":"10.1007\/DCR.0b013e3181ce8b01"},{"key":"2025090712452755000_67.6.1181.75","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.gie.2017.01.025","article-title":"Exploring endoscopic therapy for the treatment of Crohn\u2019s\u00a0 disease-related fistula and abscess","volume":"85","author":"Shen","year":"2017","journal-title":"Gastrointest Endosc"},{"key":"2025090712452755000_67.6.1181.76","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1097\/MIB.0000000000000409","article-title":"Use of endoscopic ultrasound to guide adalimumab Treatment in perianal Crohn\u2019s disease results in faster fistula healing","volume":"21","author":"Wiese","year":"2015","journal-title":"Inflamm Bowel Dis"},{"key":"2025090712452755000_67.6.1181.77","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1016\/j.gie.2015.04.020","article-title":"Endoscopically placed guidewire-assisted seton for an ileal pouch-pouch fistula","volume":"82","author":"Sinh","year":"2015","journal-title":"Gastrointest Endosc"},{"key":"2025090712452755000_67.6.1181.78","doi-asserted-by":"publisher","DOI":"10.1111\/j.1463-1318.2009.01811.x"},{"key":"2025090712452755000_67.6.1181.79","doi-asserted-by":"publisher","DOI":"10.1097\/DCR.0b013e318239d1e4"},{"key":"2025090712452755000_67.6.1181.80","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s00384-015-2281-z","article-title":"Healing of a chronic anal stump sinus after administration of combined high-concentration dextrose and doxycycline solution","volume":"31","author":"Nyabanga","year":"2016","journal-title":"Int J Colorectal Dis"},{"key":"2025090712452755000_67.6.1181.81","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1016\/j.jvir.2011.01.453","article-title":"Percutaneous embolization of persistent biliary and enteric fistulas with Histoacryl","volume":"22","author":"Bae","year":"2011","journal-title":"J Vasc Interv Radiol"},{"key":"2025090712452755000_67.6.1181.82","doi-asserted-by":"crossref","first-page":"481","DOI":"10.4293\/108680813X13693422521999","article-title":"Healing of complicated gastric leaks in bariatric patients using endoscopic clips","volume":"17","author":"Ritter","year":"2013","journal-title":"JSLS"},{"key":"2025090712452755000_67.6.1181.83","doi-asserted-by":"crossref","first-page":"2222","DOI":"10.1097\/MIB.0000000000000433","article-title":"Endoscopic therapy in Crohn\u2019s disease: Principle, preparation, and technique","volume":"21","author":"Chen","year":"2015","journal-title":"Inflamm Bowel Dis"},{"key":"2025090712452755000_67.6.1181.84","doi-asserted-by":"publisher","DOI":"10.1016\/j.gie.2014.03.049"},{"key":"2025090712452755000_67.6.1181.85","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jcol.2014.03.003","article-title":"Closure of leak at the tip of the \u201cJ\u201d after ileal pouch-anal anastomosis using a novel over-the-scope clipping system","volume":"34","author":"Lian","year":"2014","journal-title":"J Coloproctol"},{"key":"2025090712452755000_67.6.1181.86","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1007\/s10151-015-1284-7","article-title":"The OTSC(\u00ae) proctology clip system for the closure of refractory anal fistulas","volume":"19","author":"Mennigen","year":"2015","journal-title":"Tech Coloproctol"},{"key":"2025090712452755000_67.6.1181.87","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1097\/MCG.0000000000000336","article-title":"A large multicenter experience with endoscopic suturing for management of gastrointestinal defects and stent anchorage in 122 patients: A retrospective Review","volume":"50","author":"Sharaiha","year":"2016","journal-title":"J Clin Gastroenterol"},{"key":"2025090712452755000_67.6.1181.88","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1055\/s-0042-114036","article-title":"Safety and efficacy of fistula closure by endoscopic suturing: a multi-center study","volume":"48","author":"Mukewar","year":"2016","journal-title":"Endoscopy"},{"key":"2025090712452755000_67.6.1181.89","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1111\/apt.12894","article-title":"Anorectal stricture in 102 patients with Crohn\u2019s disease: natural history in the era of biologics","volume":"40","author":"Brochard","year":"2014","journal-title":"Aliment Pharmacol Ther"},{"key":"2025090712452755000_67.6.1181.90","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1097\/MIB.0000000000001044","article-title":"Endoscopic stricturotomy with needle knife in the treatment of strictures from inflammatory bowel disease","volume":"23","author":"Lan","year":"2017","journal-title":"Inflamm Bowel Dis"},{"key":"2025090712452755000_67.6.1181.91","doi-asserted-by":"crossref","unstructured":"Bemelman WA , Warusavitarne J , Sampietro GM , et al . ECCO-ESCP Consensus on Surgery for Crohn\u2019s Disease. J Crohns Colitis 2017.","DOI":"10.1093\/ecco-jcc\/jjx061"},{"key":"2025090712452755000_67.6.1181.92","first-page":"581","article-title":"Total anal sphincter saving technique for fistula-in-ano; the ligation of intersphincteric fistula tract","volume":"90","author":"Rojanasakul","year":"2007","journal-title":"J Med Assoc Thai"},{"key":"2025090712452755000_67.6.1181.93","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-009-0522-2"},{"key":"2025090712452755000_67.6.1181.94","doi-asserted-by":"crossref","first-page":"604","DOI":"10.1097\/DCR.0000000000000374","article-title":"The ligation of the intersphincteric fistula tract procedure for anal fistula: a mixed bag of results","volume":"58","author":"Sirany","year":"2015","journal-title":"Dis Colon Rectum"},{"key":"2025090712452755000_67.6.1181.95","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1111\/codi.13668","article-title":"Increasing experience of LIFT procedure for patients with Crohn\u2019s disease: what have we learned?","volume":"19","author":"Kami\u0144ski","year":"2017","journal-title":"Colorectal Dis"},{"key":"2025090712452755000_67.6.1181.96","doi-asserted-by":"publisher","DOI":"10.1007\/s10151-011-0769-2"},{"key":"2025090712452755000_67.6.1181.97","doi-asserted-by":"crossref","first-page":"424","DOI":"10.1016\/j.amjsurg.2005.10.050","article-title":"Carbon dioxide laser ablation of perianal fistulas in patients with Crohn\u2019s disease: experience with 27 patients","volume":"191","author":"Moy","year":"2006","journal-title":"Am J Surg"},{"key":"2025090712452755000_67.6.1181.98","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1007\/s10151-011-0726-0","article-title":"A new technique for sphincter-preserving anal fistula repair using a novel radial emitting laser probe","volume":"15","author":"Wilhelm","year":"2011","journal-title":"Tech Coloproctol"},{"key":"2025090712452755000_67.6.1181.99","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1111\/codi.12440","article-title":"Closure of fistula-in-ano with laser\u2013FiLaC\u2122: an effective novel sphincter-saving procedure for complex disease","volume":"16","author":"Giamundo","year":"2014","journal-title":"Colorectal Dis"},{"key":"2025090712452755000_67.6.1181.100","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1007\/s10151-015-1282-9","article-title":"Fistula-tract Laser Closure (FiLaC\u2122): long-term results and new operative strategies","volume":"19","author":"Giamundo","year":"2015","journal-title":"Tech Coloproctol"},{"key":"2025090712452755000_67.6.1181.101","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s10151-017-1599-7","article-title":"Five years of experience with the FiLaC\u2122 laser for fistula-in-ano management: long-term follow-up from a single institution","volume":"21","author":"Wilhelm","year":"2017","journal-title":"Tech Coloproctol"},{"key":"2025090712452755000_67.6.1181.102","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2036.2005.02456.x"},{"key":"2025090712452755000_67.6.1181.103","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2010.02.013"},{"key":"2025090712452755000_67.6.1181.104","doi-asserted-by":"publisher","DOI":"10.1007\/s10350-006-0755-3"},{"key":"2025090712452755000_67.6.1181.105","unstructured":"Ommer A , Herold A , Joos A , et al . Gore BioA fistula plug in the treatment of high anal fistulas \u2013 initial results from a German multicenter-study. Ger Med Sci 2012;10. Doc13.doi:10.3205\/000164"},{"key":"2025090712452755000_67.6.1181.106","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1111\/codi.13268","article-title":"The anal fistula plug in Crohn\u2019s disease patients with fistula-in-ano: a systematic review","volume":"18","author":"Nasseri","year":"2016","journal-title":"Colorectal Dis"}],"container-title":["Gut"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/gutjnl-2017-314918","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,7]],"date-time":"2025-09-07T19:45:41Z","timestamp":1757274341000},"score":1,"resource":{"primary":{"URL":"https:\/\/gut.bmj.com\/lookup\/doi\/10.1136\/gutjnl-2017-314918"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,13]]},"references-count":106,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2018,5,8]]},"published-print":{"date-parts":[[2018,6]]}},"alternative-id":["10.1136\/gutjnl-2017-314918"],"URL":"https:\/\/doi.org\/10.1136\/gutjnl-2017-314918","relation":{},"ISSN":["0017-5749","1468-3288"],"issn-type":[{"value":"0017-5749","type":"print"},{"value":"1468-3288","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,13]]}}}