Endoscopic Management of Fistulas and Abscesses in Crohn’s Disease

Abstract

Fistulas and abscesses in Crohn’s disease (CD) are mechanical complications of long term disease and can indicate an aggressive disease course. Usually chronic inflammation leads to stricture which leads to high intra-luminal pressure with resultant fistula and abscess upstream to stricture. Exceptions to that may include perianal fistulizing CD which may even precede luminal CD. Hence, management of fistula and abscesses entails management of associated strictures without which these are bound to recur. These mechanical complications (stricture/fistula/abscess) usually occur after initial 4–5 years of disease. Traditionally the management of these complications include surgical therapy. However, surgical therapy can be associated with substantial morbidity specially in these patients on immunosuppressive medications and post-operative recurrence is not uncommon. Interventional radiological procedures to drain intra-abdominal/pelvic abscess can be helpful provided that there are no intervening bowel loops. Hence, there is an unmet need of relatively less invasive endoscopic therapies for treatment of CD related fistulas and abscesses. In this chapter, we shall discuss the role of endoscopic therapy in CD related fistula and abscess.