Endoscopic ultrasound to guide the combined medical and surgical management of pediatric perianal Crohn's disease

• Published in: Inflammatory bowel diseases Vol. 16; no. 3; pp. 461 - 468
• Main Authors: Rosen, Michael J., Moulton, Dedrick E., Koyama, Tatsuki, Morgan, Walter M., Morrow, Stephen E., Herline, Alan J., Muldoon, Roberta L., Wise, Paul E., Polk, D. Brent, Schwartz, David A.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-03-2010
• Subjects: Adolescent; Algorithms; Anal Canal - diagnostic imaging; Anal Canal - surgery; Cohort Studies; Combined Modality Therapy; Crohn Disease - diagnostic imaging; Crohn Disease - surgery; Crohn Disease - therapy; Crohn's disease; Digestive System Surgical Procedures; endosonography; Endosonography - methods; Female; fistula; Humans; Male; pediatrics; Rectal Fistula - diagnostic imaging; Rectal Fistula - surgery; Rectal Fistula - therapy; Retrospective Studies; Treatment Outcome; Wound Healing; Young Adult
• ISSN: 1078-0998; 1536-4844
• DOI: 10.1002/ibd.21067

Background:
Perianal fistulas are a debilitating manifestation of Crohn's disease (CD) in the pediatric population and present a management challenge. The aims of this study were to describe our experience using endoscopic ultrasound (EUS) to guide management of perianal CD (PCD) in a pediatric population, and determine whether using EUS to monitor healing after seton placement improves outcomes.
Methods:
We conducted a retrospective study of 2 cohorts: pediatric subjects with PCD who underwent EUS and pediatric subjects who underwent seton placement between 2002 and 2007.
Results:
In all, 25 children underwent a total of 42 EUS procedures. Of 28 EUSs performed to evaluate suspected perianal disease, complex fistulizing disease was identified in 15 (54%). Setons were placed after most EUSs demonstrating complex fistulizing disease and after none demonstrating superficial or no fistulizing disease. Of 14 EUSs performed to monitor healing around a seton, 7 (50%) demonstrated persistent peri‐seton inflammation. Setons were more often left in place after an EUS revealing persistent inflammation (86% versus 0%), and the patients were more likely to have a biologic initiated or changed (57% versus 0%). Among all subjects who underwent seton placement, time from seton removal to recurrence was longer for those followed by EUS compared to those followed by physical exam only; however, we were not powered to test for statistical significance.
Conclusions:
EUS to guide the combined medical and surgical management of PCD is feasible in the pediatric population. Larger prospective studies are needed to determine if EUS‐directed management improves outcomes in pediatric patients with PCD. (Inflamm Bowel Dis 2010)