S H Emile, J Dourado, P Rogers, A Wignakumar, N Horesh, Z Garoufalia, S D Wexner
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Underlying fistula etiologies were Crohn's disease (30 studies) and cryptoglandular disease (12 studies). The main origin of stem cells was from adipose tissue (34 studies) or bone marrow (6 studies). The median follow-up duration was 12 months. The combined overall pooled healing rate was 58.1% (95% confidence interval (CI) 51.5-64.7%). The pooled healing rate for Crohn's fistulas was 60.4% (95% CI 54.7-66.2%) with adipose-derived stem cells and 63.6% (95% CI 49.4-77.7%) with bone-marrow-derived cells. The pooled healing rate for cryptoglandular fistulas was 53.8% (95% CI 35.5-72.2%) with adipose-derived stem cells. The pooled complication rate was 37.3% (95% CI 27.1-47.5%). Stem cells were associated with higher odds of anal fistula healing (odds ratio (OR): 1.81, p = 0.003) and similar odds of complications (OR: 1, p = 0.986) compared with controls.</p><p><strong>Conclusions: </strong>Stem cell treatment of anal fistulas was associated with promising results. The healing rate in Crohn's anal fistulas was higher than in cryptoglandular fistulas. Bone-marrow-derived stem cells were associated with marginally better outcomes than were adipose-derived cells. This finding suggests that the autoimmune inflammatory etiology of Crohn's disease may respond better to autologous myoblasts than does the infectious etiology of cryptoglandular fistulas.</p>","PeriodicalId":51192,"journal":{"name":"Techniques in Coloproctology","volume":"29 1","pages":"100"},"PeriodicalIF":2.9000,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11982159/pdf/","citationCount":"0","resultStr":"{\"title\":\"Systematic review and meta-analysis of the efficacy and safety of stem cell treatment of anal fistulas.\",\"authors\":\"S H Emile, J Dourado, P Rogers, A Wignakumar, N Horesh, Z Garoufalia, S D Wexner\",\"doi\":\"10.1007/s10151-025-03138-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Since anal fistulas can be challenging to treat; numerous innovative treatments have been proposed, including stem cell therapy. 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引用次数: 0
摘要
背景：由于肛瘘的治疗具有挑战性；已经提出了许多创新的治疗方法，包括干细胞治疗。本系统综述旨在评估与干细胞治疗相关的瘘管愈合和不良事件的汇总率。方法：在这个符合prisma标准的系统综述中，我们检索了PubMed和Scopus，以报告干细胞治疗肛瘘的结果的观察性和随机研究。主要观察指标为干细胞治疗的成功愈合和不良反应。结果：共纳入43项研究，纳入1160例患者，其中男性53.6%。潜在的瘘管病因是克罗恩病（30项研究）和隐腺病（12项研究）。干细胞主要来源于脂肪组织（34项研究）或骨髓（6项研究）。中位随访时间为12个月。综合总愈合率为58.1%（95%可信区间（CI） 51.5-64.7%）。脂肪来源的干细胞治疗克罗恩瘘管的总治愈率为60.4% (95% CI 54.7-66.2%)，骨髓来源的细胞治疗克罗恩瘘管的总治愈率为63.6% （95% CI 49.4-77.7%）。脂肪源性干细胞治疗隐腺瘘的总愈合率为53.8% （95% CI 35.5-72.2%）。合并并发症发生率为37.3% （95% CI 27.1-47.5%）。与对照组相比，干细胞组肛瘘愈合的几率更高（比值比（OR）： 1.81, p = 0.003），并发症的几率相似（OR: 1, p = 0.986）。结论：肛瘘的干细胞治疗具有良好的效果。克罗恩肛瘘的治愈率高于隐腺瘘管。与脂肪来源的细胞相比，骨髓来源的干细胞的预后略好。这一发现表明，自体成肌细胞对克罗恩病自身免疫性炎症病因的反应可能比隐腺瘘感染性病因的反应更好。
Systematic review and meta-analysis of the efficacy and safety of stem cell treatment of anal fistulas.
Background: Since anal fistulas can be challenging to treat; numerous innovative treatments have been proposed, including stem cell therapy. This systematic review aimed to assess pooled rates of fistula healing and adverse events associated with stem cell treatment.
Methods: In this PRISMA-compliant systematic review we searched PubMed and Scopus for observational and randomized studies reporting outcomes of stem cell treatment for anal fistulas. The main outcome measures were successful healing and adverse effects of stem cell therapy.
Results: In total, 43 studies incorporating 1160 patients (53.6% male) were included. Underlying fistula etiologies were Crohn's disease (30 studies) and cryptoglandular disease (12 studies). The main origin of stem cells was from adipose tissue (34 studies) or bone marrow (6 studies). The median follow-up duration was 12 months. The combined overall pooled healing rate was 58.1% (95% confidence interval (CI) 51.5-64.7%). The pooled healing rate for Crohn's fistulas was 60.4% (95% CI 54.7-66.2%) with adipose-derived stem cells and 63.6% (95% CI 49.4-77.7%) with bone-marrow-derived cells. The pooled healing rate for cryptoglandular fistulas was 53.8% (95% CI 35.5-72.2%) with adipose-derived stem cells. The pooled complication rate was 37.3% (95% CI 27.1-47.5%). Stem cells were associated with higher odds of anal fistula healing (odds ratio (OR): 1.81, p = 0.003) and similar odds of complications (OR: 1, p = 0.986) compared with controls.
Conclusions: Stem cell treatment of anal fistulas was associated with promising results. The healing rate in Crohn's anal fistulas was higher than in cryptoglandular fistulas. Bone-marrow-derived stem cells were associated with marginally better outcomes than were adipose-derived cells. This finding suggests that the autoimmune inflammatory etiology of Crohn's disease may respond better to autologous myoblasts than does the infectious etiology of cryptoglandular fistulas.
期刊介绍：
Techniques in Coloproctology is an international journal fully devoted to diagnostic and operative procedures carried out in the management of colorectal diseases. Imaging, clinical physiology, laparoscopy, open abdominal surgery and proctoperineology are the main topics covered by the journal. Reviews, original articles, technical notes and short communications with many detailed illustrations render this publication indispensable for coloproctologists and related specialists. Both surgeons and gastroenterologists are represented on the distinguished Editorial Board, together with pathologists, radiologists and basic scientists from all over the world. The journal is strongly recommended to those who wish to be updated on recent developments in the field, and improve the standards of their work.
Manuscripts submitted for publication must contain a statement to the effect that all human studies have been reviewed by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in an appropriate version of the 1965 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the Principles of Laboratory Animal Care (NIH publication no. 86-23 revised 1985) were followed as were applicable national laws (e.g. the current version of the German Law on the Protection of Animals). The Editor-in-Chief reserves the right to reject manuscripts that do not comply with the above-mentioned requirements. Authors will be held responsible for false statements or for failure to fulfill such requirements.
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