Gastrointest Endosc Clin N Am. 2022 Oct;32(4):733-746.doi: 10.1016/j.giec.2022.05.006. Epub 2022 Sep 7.

Nan Lan ¹, Bo Shen ²

Author information

¹Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, 161 Fort Washington Avenue, HIP Floor 8-843, New York, NY 10032, USA.

²Center for Inflammatory Bowel Disease, Columbia University Irving Medical Center-NewYork Presbyterian Hospital, 161 Fort Washington Avenue, HIP Floor 8-843, New York, NY 10032, USA. Electronic address: bs3270@cumc.columbia.edu.

Abstract

Crohn disease (CD) patients can develop fistula or abscess from persistent active disease or postsurgical complications. Penetrating CD is traditionally treated with medication and surgery. The role of medication alone in the treatment of fistula is limited, except perianal fistulas or enterocutaneous fistula. Surgery is the standard treatment in those with hollow-organ to hollow-organ fistula, like ileovesicular fistula. Surgery is invasive with a higher risk of postoperative complications. Endoscopic therapy has evolved as a valid option. Fistulotomy, surgical or endoscopic, should be considered first-line therapy when feasible. Incision and drainage of perianal abscesses with an endoscopic device may be attempted.