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World J Gastroenterol. Jul 28, 2024; 30(28): 3373-3385
Published online Jul 28, 2024. doi: 10.3748/wjg.v30.i28.3373
Perianal disease in inflammatory bowel disease: Broadening treatment and surveillance strategies for anal cancer
Tatiana Pacheco, Sara Monteiro, Luísa Barros, Jorge Silva
Tatiana Pacheco, Sara Monteiro, Luísa Barros, Jorge Silva, Department of Gastroenterology, Centro Hospitalar do Tâmega e Sousa, Penafiel 4560-136, Portugal
Author contributions: All authors made substantial contributions to the article. Pacheco T performed the literature research and drafted the manuscript; Monteiro S reviewed the manuscript and provided critical input on its intellectual content and structure; Barros L and Silva J critically revised the manuscript; All authors have approved the final version of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tatiana Pacheco, MD, Doctor, Department of Gastroenterology, Centro Hospitalar do Tâmega e Sousa, Avenida do Hospital Padre Américo, 210, Penafiel 4560-136, Portugal. tatianasofiaapacheco@gmail.com
Received: March 26, 2024
Revised: June 17, 2024
Accepted: July 8, 2024
Published online: July 28, 2024
Processing time: 119 Days and 8.5 Hours
Abstract

The perianal disease affects up to one-third of individuals with Crohn's disease (CD), causing disabling symptoms and significant impairment in quality of life, particularly for those with perianal fistulising CD (PFCD). The collaborative effort between gastroenterologists and surgeons is essential for addressing PFCD to achieve fistula closure and promote luminal healing. Limited fistula healing rates with conventional therapies have prompted the emergence of new biological agents, endoscopic procedures and surgical techniques that show promising results. Among these, mesenchymal stem cells injection is a particularly hopeful therapy. In addition to the burden of fistulas, individuals with perianal CD may face an increased risk of developing anal cancer. This underscores the importance of surveillance programmes and timely interventions to prevent late diagnoses and poor outcomes. Currently, there is no established formal anal screening programme. In this review, we provide an overview of the current state of the art in managing PFCD, including novel medical, endoscopic and surgical approaches. The discussion also focuses on the relevance of establishing an anal cancer screening programme in CD, intending to propose a risk-based surveillance algorithm. The validation of this surveillance programme would be a significant step forward in improving patient care and outcomes.

Keywords: Inflammatory bowel disease; Crohn's disease; Perianal; Fistula; Anus diseases; Management; Anal cancer; Screening

Core Tip: Perianal fistulising Crohn's disease remains one of the most complex phenotypes of inflammatory bowel disease. Effective management involves a multidisciplinary approach. This review seeks to assess the existing evidence and emerging literature to provide clinicians with objective guidance for clinical practice concerning the optimal medical, endoscopic and surgical treatment of perianal fistulas. Future directions in management are also being reviewed. Additionally, the discussion underscores the significance of implementing an anal cancer screening programme, given the heightened risk faced by these patients. An algorithm for anal cancer screening is proposed with the ultimate goal of enhancing patient outcomes.