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Review
. 2024 Jul 28;30(28):3373-3385.
doi: 10.3748/wjg.v30.i28.3373.

Perianal disease in inflammatory bowel disease: Broadening treatment and surveillance strategies for anal cancer

Tatiana Pacheco  1 , Sara Monteiro  2 , Luísa Barros  2 , Jorge Silva  2
Affiliations
Review

Perianal disease in inflammatory bowel disease: Broadening treatment and surveillance strategies for anal cancer

Tatiana Pacheco et al. World J Gastroenterol. .

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

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Suggested algorithm for management of perianal fistulising Crohn's disease. TNF: Tumour necrosis factor; LIFT: Ligation of the intersphincteric fistula tract; VAAFT: Video-assisted anal fistula treatment; FiLaC: Fistula laser closure; MSC: Mesenchymal stem cell.
Figure 2
Figure 2
Proposed surveillance algorithm for anal cancer patients with Crohn's disease.
See this image and copyright information in PMC

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