Another very good review by David Schwartz on The Daunting Duo: Management of Stictures and Fistula. Below are some of my notes and some slides; my notes may contain errors in transcription or omission. Can get access to all 49 slides here: IBD Pro CCFA 2023 Atlanta

• Fistula healing rates are poor
• 78% have complex fistulas
• Long-term healing: 67% with simple fistulas but only 37% with complex fistulas
• Seton placement prior to biologic therapy increases likelihood of better outcomes
• Antibiotic therapy recommended until Seton removed (not short-term treatment) –improved healing rates along with medical therapy
• Anti-TNF therapy effective in ~40% long-term; higher rates of healing with higher anti-TNF levels
• MRI and/or EUS helpful in improving fistula healing rates
• Ustekinumab and Vedolizumab both had fistula healing rates ~40%
• Adipose derived stem cells with ~50% healing rates (study with high placebo healing rate too ~37%); changes local cytokine profile, cells gone in about 2 weeks but goal for changing trajectory

Strictures

• 5-24% with stricturing phenotype
• No effective medical treatments
• Endoscopic balloon dilatation in shorter strictures (<5 cm) without associated abscess or fistula (needs imaging prior)
• One-third of balloon dilated strictures will still wind up needing surgery despite dilatation. 5-10% risk of complication. Goal is 15 mm or more (Dr. Schwartz typically does not increase by more than 3 sizes from baseline in one session)

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