Diagnosing Crohn's Disease in Presumed Cryptoglandular Perianal Fistulas: An Expert Delphi Consensus on Early Identification of Patients at Risk of Crohn's Disease in Perianal Fistulas (PREFAB).

Background: The aim of this Delphi study was to reach consensus on a new clinical decision tool to help identify or exclude Crohn's disease (CD) in patients with perianal fistula(s) (PAF).

Methods: A panel of international experts in the field of proctology/Inflammatory Bowel Disease (IBD) were invited to participate. In the first round (electronic survey), participants were asked to anonymously provide their opinion probing 1) the relevance and use of clinical characteristics suggestive of underlying CD, 2) the use of faecal calprotectin (FCP) for screening for CD and 3) on the diagnostic work-up for CD in PAF patients with raised clinical suspicion.

Prolonged time to diagnosis of Crohn's disease in patients with perianal fistulas negatively affects long-term outcomes.

Background And Aim: This study aims to evaluate the effect of time to Crohn's disease (CD) diagnosis on perianal fistula (PAF) outcomes in patients with a fistula as first manifesting sign.

Methods: In this multicenter, retrospective study, CD patients with a PAF preceding CD diagnosis between November 2015 and June 2022 were included. The primary outcome parameter was the time to CD diagnosis and its correlation with long-term outcomes.

Fistulizing Perianal Disease as a First Manifestation of Crohn's Disease: A Systematic Review and Meta-Analysis.

: Incidences of perianal fistulas (PAFs) as a first manifestation of Crohn's disease (CD) vary widely in the literature. Aim: To analyse the percentage of patients with a PAF preceding CD diagnosis and assess the time to diagnosis. : A systematic literature search was conducted.

Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones: 5-Year Follow-Up of the SECURE Randomized Clinical Trial.

Importance: The 1-year results of the SECURE trial, a randomized trial comparing a restrictive strategy vs usual care for select patients with symptomatic cholelithiasis for cholecystectomy, resulted in a significantly lower operation rate after restrictive strategy. However, a restrictive strategy did not result in more pain-free patients at 1 year.

Objective: To gauge pain level and determine the proportion of pain-free patients, operation rate, and biliary and surgical complications at the 5-year follow-up.

Perianal Fistulizing Crohn's Disease: Utilizing the TOpClass Classification in Clinical Practice to Provide Targeted Individualized Care.

Background & Aims: Perianal fistulation is a challenging phenotype of Crohn's disease, with significant impact on quality of life. Historically, fistulae have been classified anatomically in relation to the sphincter complex, and management guidelines have been generalized, with lack of attention to the clinical heterogenicity seen. The recent 'TOpClass classification system' for perianal fistulizing Crohn's disease (PFCD) addresses this issue, and classifies patients into defined groups, which provide a focus for fistula management that aligns with disease characteristics and patient goals.