Determination of the approach of Polish gastroenterologists and surgeons to the diagnosis and treatment of complex cases of Crohn's disease-related perianal fistulas.

Abstract

Introduction: Crohn's disease (CD) is a chronic, relapsing inflammatory disorder that can affect any part of the gastrointestinal tract. CD-related perianal fistulas are difficult to treat and require coordinated surgical-medical care.

Aim: The aim of this study was to describe how Polish gastroenterologists and surgeons diagnose and manage complex perianal fistulas associated with Crohn's disease during initial and subsequent lines of treatment, including surgical care.

Material and methods: A nationwide retrospective analysis was conducted, including a review of the medical records of 80 patients with complex perianal fistulas after failure of standard therapy, and surveys of 27 gastroenterologists representing the majority of centres involved in the B.32 programme and 12 colorectal surgeons (February-March 2023).

Results: In surveys, clinicians estimated that about 20% of their CD patients currently had a perianal fistula, while another 20% had a history of one; 24% of first fistulas reportedly preceded CD diagnosis, 36% occurred within 3 years, and 13% after > 10 years. Magnetic resonance imaging was the most frequently used imaging modality for complex fistulas. In the chart cohort, initial ("standard") therapy most often combined azathioprine, antibiotics, metronidazole, and glucocorticoids (median duration 13 weeks). After failure, 80% received combined surgical-medical care; 91% received biologics as first or second post-failure therapy (infliximab n = 51/80, 63.8%; adalimumab n = 13/80, 16.3%; vedolizumab n = 3/80, 3.8%; ustekinumab n = 1/80, 1.3%). Surgeons most commonly performed abscess drainage, seton placement, and fistulectomy. Reported barriers included long waits for MRI and limited access to centres specialising in the treatment of perianal fistulas.

Conclusions: Management patterns vary and interdisciplinary coordination is inconsistent; structured care pathways and multidisciplinary clinics are needed in Poland.