Ligation of the intersphincteric fistula tract (LIFT) procedure is increasingly used for surgical closure of high perianal fistulas in Crohn’s disease. Currently, data on postoperative MRI findings is scarce, while considered most important to assess healing and recurrences. Therefore, we evaluated fistula characteristics on MRI and the relation with clinical outcomes after LIFT.
Consecutive Crohn’s patients treated with LIFT between 2007 and 2018 who underwent baseline and follow-up MRI were retrospectively included. MRI’s were scored by two radiologists according to characteristics based on the original and modified Van Assche indices. MRI findings, with emphasis on fibrosis, and the relation with clinical healing, reinterventions and recurrences were described.
Twelve patients were included (4 male, median age 34 (IQR 28-39) years). Follow-up MRI was performed at a median of 5.5 months (IQR 2.5-6.0) after LIFT. At baseline, all patients showed a tract with predominantly granulation tissue, which changed to predominantly fibrotic in seven, of which completely fibrotic in three. All patients with a (predominantly) fibrotic tract had clinical closure and no reinterventions or recurrences during long-term follow-up. In contrast, of the five patients with persisting granulation tissue, two reached clinical healing, two needed re-interventions and one had a recurrence.
A markedly decreased fistula activity can be observed on MRI after LIFT. The majority of patients develop a predominantly fibrotic tract relatively soon after LIFT without clinical recurrences, suggesting a highly effective therapy. Unfavourable clinical outcomes were only present in patients with persisting granulation tissue, indicating a potential prognostic value of MRI.

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