Treatment of chronic anal fissure in Crohn's disease patients with freshly collected autologous adipose tissue: a pilot study

Early human evidence such as case series or small samples is exploring possible benefits.

• Level A · Stronger Clinical Evidence
• Level B · Emerging clinical evidence with positive signals
• Level C · Early human research exploring benefits
• Level D · Scientific groundwork from lab and animal studies
• Emerging · Emerging topic under active research

Abstract (original English)

Background Chronic anal fissures in patients with Crohn's disease (CD) remain a significant therapeutic challenge, particularly when linked to active perianal disease. Conventional treatments often fail, highlighting the need for alternative approaches. This study explores the efficacy and safety of freshly collected autologous adipose tissue injection (AATI) for treating chronic fissures in patients with CD. Methods Nine patients with CD with anal fissures were included. The primary outcome was complete healing (CH) at 3 months after last AATI, defined as full fissure re-epithelialization and complete pain relief. Secondary outcomes included changes in defecation pain (visual analog scale [VAS]), anal discomfort (VAS), Perianal Disease Activity Index (PDAI), and St. Mark's Incontinence Score (SMIS). Results Five patients (56%) achieved CH after one (n = 4) or two (n = 1) AATI. Partial healing was observed in four patients (44%). Defecation pain improved from a VAS score of 7.5 (IQR 5.0-8.5) to 2.75 (0.0-4.5; p = 0.009), anal discomfort from VAS score of median 5.0 (2.5-6.5) to 1.0 (0.0-2.5; p = 0.014), PDAI from 5.0 (3.0-6.0) to 1.0 (1.0-2.0; p = 0.022), and SMIS from 7.0 (4.0-9.0) to 4.0 (0.0-4.0; p = 0.041). No treatment-related complications occurred. Conclusion AATI may be a promising new treatment of chronic anal fissures in patients with CD. Effects of AATI should be exp

Evidence level

Early human evidence such as case series or small samples is exploring possible benefits.

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