{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T17:26:16Z","timestamp":1785000376421,"version":"3.55.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"S7","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Proc"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Complex perianal fistula is a common complication of Crohn\u2019s disease (CD) which leads to negative impact on patient\u2019s quality of life. Successful management of the disease requires a multidisciplinary approach, including a gastroenterologist and a colorectal surgeon, applying combined surgical and medical therapy. One of frequently practiced surgical procedures is seton placement in the fistula tract, which is used to control perianal sepsis and drain the fistula, while preventing recurrent abscess formation.<\/jats:p><jats:p>Darvadstrocel, a suspension of expanded, allogeneic, adipose-derived, mesenchymal stem cells, is safe and effective for treatment-refractory complex perianal fistulas in patients with Crohn\u2019s disease. Following approval of darvadstrocel, the INSPIRE registry is being conducted in order to evaluate long-term safety and effectiveness of the drug on a large, heterogenous population.<\/jats:p><jats:p>An online expert meeting was held from March 20 to March 30, 2023, which provided relevant insights into the decision-making process regarding seton use and obtained feedback on the first experiences with darvadstrocel. The aim of this article is to present the perspectives from gastroenterologists and colorectal surgeons practicing in Czechia, Hungary, Israel, Lithuania, Serbia, and Slovenia in topics such as diagnosis and treatment options for patients with complex Crohn's\u00a0perianal fistulas\u00a0(CPF), specifically focusing on the use of setons and darvadstrocel.<\/jats:p><jats:p>During this virtual session, unavailability of comprehensive data on safety and efficacy of available treatment procedures was emphasized as an important obstacle towards development of standardized recommendations and improvement of outcomes in treatment of (CPF). Furthermore, achieving consensus in seton use, duration of its placement, and frequency of change is recognized as one of CPF treatments major challenges. Despite these issues, it is important to promote better understanding and treatment of complex perianal fistulas in order to improve the quality of life of those affected by this condition.<\/jats:p>","DOI":"10.1186\/s12919-024-00291-4","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T23:02:34Z","timestamp":1713999754000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Insights into treatment of complex Crohn's\u00a0perianal fistulas"],"prefix":"10.1186","volume":"18","author":[{"given":"Gregor","family":"Nor\u010di\u010d","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nata\u0161a","family":"Smrekar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sr\u0111an","family":"Markovi\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Goran","family":"Bari\u0161i\u0107","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gediminas","family":"Kiudelis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrikas","family":"Pau\u017eas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tam\u00e1s","family":"Moln\u00e1r","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Attila","family":"Szijarto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zuzana","family":"\u0160erclov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tina","family":"Roblek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Viktor","family":"Ur\u0161i\u010d","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"White","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"issue":"1","key":"291_CR1","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3393\/ac.2021.02.08","volume":"37","author":"JL Lee","year":"2021","unstructured":"Lee JL, et al. Treatment Strategy for Perianal Fistulas in Crohn Disease Patients: The Surgeon\u2019s Point of View. Annals of coloproctology. 2021;37(1):5\u201315. https:\/\/doi.org\/10.3393\/ac.2021.02.08.","journal-title":"Annals of coloproctology"},{"issue":"8","key":"291_CR2","doi-asserted-by":"publisher","first-page":"1049","DOI":"10.1093\/ecco-jcc\/jjaa004","volume":"14","author":"KA Wasmann","year":"2020","unstructured":"Wasmann KA, et al. Treatment of Perianal Fistulas in Crohn\u2019s Disease, Seton Versus Anti-TNF Versus Surgical Closure Following Anti-TNF [PISA]: A Randomised Controlled Trial. J Crohns Colitis. 2020;14(8):1049\u201356. https:\/\/doi.org\/10.1093\/ecco-jcc\/jjaa004.","journal-title":"J Crohns Colitis"},{"key":"291_CR3","unstructured":"European Medicine Agency. Press release: New medicine to treat perianal fistulas in patients with Crohn\u2019s disease. 2017. https:\/\/www.ema.europa.eu\/en\/news\/new-medicine-treat-perianal-fistulas-patients-crohns-disease."},{"issue":"2","key":"291_CR4","doi-asserted-by":"publisher","first-page":"129","DOI":"10.20524\/aog.2018.0236","volume":"31","author":"SO Adegbola","year":"2018","unstructured":"Adegbola SO, et al. Medical and surgical management of perianal Crohn\u2019s disease. Ann Gastroenterol. 2018;31(2):129\u201339. https:\/\/doi.org\/10.20524\/aog.2018.0236.","journal-title":"Ann Gastroenterol"},{"issue":"9","key":"291_CR5","first-page":"521","volume":"14","author":"SL Gold","year":"2018","unstructured":"Gold SL, et al. Perianal Fistulas in Patients With Crohn\u2019s Disease, Part 2: Surgical, Endoscopic, and Future Therapies. Gastroenterol Hepatol (N Y). 2018;14(9):521\u20138 PMID: 30364296; PMCID: PMC6194657.","journal-title":"Gastroenterol Hepatol (N Y)."},{"issue":"1","key":"291_CR6","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1055\/s-0035-1570392","volume":"29","author":"EJ Bubbers","year":"2016","unstructured":"Bubbers EJ, Cologne KG. Management of Complex Anal Fistulas. Clin Colon Rectal Surg. 2016;29(1):43\u20139. https:\/\/doi.org\/10.1055\/s-0035-1570392.","journal-title":"Clin Colon Rectal Surg"},{"key":"291_CR7","unstructured":"Alofisel Summary of Product Characteristics. Available at: https:\/\/www.ema.europa.eu\/en\/documents\/product-information\/alofisel-epar-product-information_en.pdf. Last accessed June 2023."},{"issue":"5","key":"291_CR8","doi-asserted-by":"publisher","first-page":"713","DOI":"10.1097\/DCR.0000000000002325","volume":"65","author":"D Garcia-Olmo","year":"2022","unstructured":"Garcia-Olmo D, et al. Follow-up Study to Evaluate the Long-term Safety and Efficacy of Darvadstrocel (Mesenchymal Stem Cell Treatment) in Patients With Perianal Fistulizing Crohn\u2019s Disease: ADMIRE-CD Phase 3 Randomized Controlled Trial. Dis Colon Rectum. 2022;65(5):713\u201320. https:\/\/doi.org\/10.1097\/DCR.0000000000002325.","journal-title":"Dis Colon Rectum"},{"key":"291_CR9","doi-asserted-by":"publisher","first-page":"i536","DOI":"10.1093\/ecco-jcc\/jjab232.729","volume":"16","author":"O Zmora","year":"2022","unstructured":"Zmora O, et al. P603 INSPIRE: 6-month interim analysis from an observational post-marketing registry on the effectiveness and safety of darvadstrocel in patients with Crohn\u2019s disease and complex perianal fistulas. J Crohns Colitis. 2022;16:i536\u20137. https:\/\/doi.org\/10.1093\/ecco-jcc\/jjab232.729.","journal-title":"J Crohns Colitis"},{"key":"291_CR10","unstructured":"Takeda Pharmaceutical Company Ltd. Alofisel\u25bc (darvadstrocel) Shows Clinical Remission Rate at Six-Months in the Real-World INSPIRE Study Interim Analysis Consistent with the Pivotal Clinical ADMIRE-CD Study. Available at: https:\/\/www.takeda.com\/newsroom\/newsreleases\/2022\/alofisel-darvadstrocel-shows-clinical-remission-rate--at-six-months-in-the-real-world-inspire-study-interim-analysis-consistent-with-the-pivotal-clinical-admire-cd-study\/ . Last accessed June 2023."},{"key":"291_CR11","doi-asserted-by":"publisher","unstructured":"Gionchetti P, et al. ECCO. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn's Disease 2016: Part 2: Surgical Management and Special Situations. J Crohns Colitis. 2017;11(2):135\u2013149. https:\/\/doi.org\/10.1093\/ecco-jcc\/jjw169.","DOI":"10.1093\/ecco-jcc\/jjw169"},{"issue":"18","key":"291_CR12","doi-asserted-by":"publisher","first-page":"1398","DOI":"10.1056\/NEJM199905063401804","volume":"340","author":"DH Present","year":"1999","unstructured":"Present DH, et al. Infliximab for the treatment of fistulas in patients with Crohn\u2019s disease. N Engl J Med. 1999;340(18):1398\u2013405. https:\/\/doi.org\/10.1056\/NEJM199905063401804. (PMID: 10228190).","journal-title":"N Engl J Med"},{"issue":"Suppl 2","key":"291_CR13","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1046\/j.1365-2036.17.s2.17.x","volume":"17","author":"R Sostegni","year":"2003","unstructured":"Sostegni R, et al. Review article: Crohn\u2019s disease: monitoring disease activity. Aliment Pharmacol Ther. 2003;17(Suppl 2):11\u20137. https:\/\/doi.org\/10.1046\/j.1365-2036.17.s2.17.x. (PMID: 12786607).","journal-title":"Aliment Pharmacol Ther"},{"issue":"10051","key":"291_CR14","doi-asserted-by":"publisher","first-page":"1281","DOI":"10.1016\/S0140-6736(16)31203-X","volume":"388","author":"J Pan\u00e9s","year":"2016","unstructured":"Pan\u00e9s J, et al. Expanded allogeneic adipose-derived mesenchymal stem cells (Cx601) for complex perianal fistulas in Crohn\u2019s disease: a phase 3 randomised, double-blind controlled trial. Lancet. 2016;388(10051):1281\u201390. https:\/\/doi.org\/10.1016\/S0140-6736(16)31203-X. (PMID: 27477896).","journal-title":"Lancet"},{"issue":"4","key":"291_CR15","doi-asserted-by":"publisher","first-page":"1253","DOI":"10.3390\/ijerph17041253","volume":"17","author":"MD Ruiz-Fern\u00e1ndez","year":"2020","unstructured":"Ruiz-Fern\u00e1ndez MD, et al. Quality of Life in Nursing Professionals: Burnout, Fatigue, and Compassion Satisfaction. Int J Environ Res Public Health. 2020;17(4):1253. https:\/\/doi.org\/10.3390\/ijerph17041253.","journal-title":"Int J Environ Res Public Health"},{"issue":"6","key":"291_CR16","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/S2468-1253(22)00007-3","volume":"7","author":"J Geldof","year":"2022","unstructured":"Geldof J, et al. Classifying perianal fistulising Crohn\u2019s disease: an expert consensus to guide decision-making in daily practice and clinical trials. Lancet Gastroenterol Hepatol. 2022;7(6):576\u201384. https:\/\/doi.org\/10.1016\/S2468-1253(22)00007-3.","journal-title":"Lancet Gastroenterol Hepatol"},{"issue":"8","key":"291_CR17","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1007\/s10151-020-02250-5","volume":"24","author":"H Guadalajara","year":"2020","unstructured":"Guadalajara H, et al. Mesenchymal stem cells in perianal Crohn\u2019s disease. Tech Coloproctol. 2020;24(8):883\u20139. https:\/\/doi.org\/10.1007\/s10151-020-02250-5. (PMID: 32488549).","journal-title":"Tech Coloproctol"}],"container-title":["BMC Proceedings"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12919-024-00291-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12919-024-00291-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12919-024-00291-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T23:03:06Z","timestamp":1713999786000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcproc.biomedcentral.com\/articles\/10.1186\/s12919-024-00291-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,25]]},"references-count":17,"journal-issue":{"issue":"S7","published-online":{"date-parts":[[2024,4]]}},"alternative-id":["291"],"URL":"https:\/\/doi.org\/10.1186\/s12919-024-00291-4","relation":{},"ISSN":["1753-6561"],"issn-type":[{"value":"1753-6561","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,25]]},"assertion":[{"value":"25 April 2024","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The meeting organized by Takeda was by invitation only. All participants accepted the invitation and attended the meeting out of their free will. All participants have signed the agreement prior to gaining access to the Virtual meeting. All participants agree with publication of the meeting report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The meeting was organized and funded by Takeda. GN, NS, SM, GB, GK, HP, TM, AS, Z\u0160, IW received participation fee based on the time spent on the virtual meeting.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"7"}}