The efficacy of adipose-derived stem cell therapy for complex perianal fistulas in Crohn's disease patients: A systematic review
Notice bibliographique
Résumé
Background: Crohn's disease (CD) is a chronic inflammatory bowel disease (IBD) that often leads to the development of complex perianal fistulas, significantly impairing patients' quality of life. Conventional medical and surgical treatments offer limited long-term efficacy, with high recurrence rates and associated complications. Adipose-derived stem cell therapy (ADSCT) has emerged as a promising regenerative therapy due to its anti-inflammatory and tissue-regenerative properties. However, discrepancies in clinical outcomes across studies warrant a systematic evaluation of its efficacy and safety. Objective: This systematic review aims to critically assess the efficacy, safety, and recurrence rates of ADSCT for complex perianal fistulas in Crohn's disease patients, summarizing data from randomized controlled trials and observational studies. Methods: This review included 19 studies published between 2009 and 2024 involving Crohn's disease patients treated with either autologous or allogeneic ADSCT. Extracted data included patient demographics, fistula characteristics, treatment protocols, and clinical outcomes such as fistula closure, partial healing, time to healing, recurrence, and adverse events. Study selection followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and is illustrated in a PRISMA flow diagram. Risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized controlled trials and adapted versions of the Newcastle-Ottawa Scale (NOS) and MINORS criteria for observational studies. Studies were categorized as excellent, good, or fair based on their total quality score. Results: Fistula closure rates ranged from 23.1 % to 91 %, with an overall average of 62.5 %. Partial healing rates varied widely, between 9 % and 93.3 %. Time to healing ranged from 8 to 48 weeks, with an average of 25.3 weeks. Recurrence rates were reported in over half of the studies and reached up to 38.5 %, with a mean recurrence rate of 19.2 %. The majority of adverse events were mild and transient, including local inflammation, discomfort, and minor infections. No serious (Grade 3 or 4) complications were reported. Risk of bias assessment classified one study as excellent, two as good, and two as fair in methodological quality. Conclusion: Adipose-derived stem cell therapy demonstrates promising efficacy and a favorable safety profile for the treatment of complex perianal fistulas in Crohn's disease. While ADSCT may achieve meaningful clinical response and symptom relief in a substantial proportion of patients, variability in outcomes and study designs highlights the need for standardized protocols and long-term follow-up in future trials.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,008 | 0,031 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,011 | 0,012 |
| Bibliométrie | 0,007 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,002 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».