Long-Term Relief for Complex Crohn's Fistulas
Silvio Laureti, Alberta Cappelli, Claudio Isopi, Lorenzo Gentilini, Riccardo Villani, Gioia Sorbi, Fernando Rizzello, Alessandra Menon, Nikolas Konstantine Dussias, Paolo Gionchetti, Gilberto Poggioli · Inflammatory Bowel Diseases · 2024
Nearly 87% success rate after almost seven years of follow-up
This study followed 15 patients with complex perianal Crohn's disease fistulas—abnormal tunnels between the intestine and skin near the anus. These patients had already tried standard treatments without success. Researchers tracked their outcomes for an average of 6.7 years after receiving injections of their own processed fat tissue (called micro-fragmented adipose tissue or MFAT). This represents the longest follow-up study ever published for this treatment approach.
Nine of ten healed patients stayed healed long-term
The results were encouraging for patients who responded to initial treatment. Of the ten patients who achieved complete healing within the first 24 weeks, nine maintained that healing throughout the entire follow-up period. Only one patient experienced a recurrence, and that person was successfully treated with a repeat procedure. This suggests that when the treatment works, the benefits tend to last for years.
Patients who didn't respond initially had second chances
Five patients did not achieve complete healing after their first MFAT injection. Here's what happened to them:
Three patients received additional treatment with MFAT
Two of those three achieved complete healing
One patient declined further treatment because their quality of life had improved enough
One patient showed delayed healing at the one-year mark
The procedure combines fat injection with surgical cleanup
The treatment involves two steps performed together. First, surgeons clean out any infection and place temporary drains to control the fistula. Then, processed fat tissue harvested from the patient's own body gets injected around the fistula tract. This fat tissue contains special healing cells called pericytes and mesenchymal stem cells. These cells help reduce inflammation and encourage the body's natural repair processes.
No serious safety concerns over nearly seven years
The treatment remained safe throughout the entire study period. Patients experienced no significant complications from the MFAT injections. This long-term safety record is important because patients with Crohn's disease often have compromised immune systems and may be taking medications that affect healing.
Why this matters for patients with difficult-to-treat fistulas
Perianal fistulas affect up to 40% of people with Crohn's disease and significantly impact quality of life. Standard treatments—including biologic medications and surgery—fail to heal fistulas in many patients. Even when healing occurs, more than 60% of patients experience a return of their fistula within one year.
This study suggests MFAT injection offers a meaningful option for patients who haven't responded to conventional approaches. The procedure uses the patient's own tissue, avoiding risks associated with donor materials. It can be performed in a single session without the weeks of laboratory processing required by some other stem cell treatments.
The 86.6% overall success rate—achieved in patients who had already failed multiple other treatments—represents a significant advancement. However, patients should understand this was a small study of 15 people at a single medical center. Larger studies with more patients are needed to confirm these findings.
Source: Laureti et al., Inflammatory Bowel Diseases, 2024.
Original Publication
Autologous Microfragmented Adipose Tissue Injection in Refractory Complex Crohn's Perianal Fistulas: Long-Term Results at 6.7 Years Mean Follow-up
Silvio Laureti, Alberta Cappelli, Claudio Isopi, Lorenzo Gentilini, Riccardo Villani, Gioia Sorbi, Fernando Rizzello, Alessandra Menon, Nikolas Konstantine Dussias, Paolo Gionchetti, Gilberto Poggioli · Inflammatory Bowel Diseases · 2024
This study evaluated the long-term efficacy and safety of autologous microfragmented adipose tissue (MFat) injection for refractory complex Crohn's perianal fistulas. Fifteen patients with complex fistulizing perianal Crohn's disease refractory to combined bio-surgical therapy were prospectively followed for a mean of 6.7 years after initial MFat injection treatment. Data on clinical and radiological remission and surgical recurrence rates were collected. At 24-week follow-up in the previous pilot study, combined remission was achieved in 66.7% of patients and clinical remission in 93%. At 6.7-year follow-up, 9 of 10 initially healed patients maintained remission. The one recurrent patient was successfully reoperated. Among 5 patients who failed primary combined remission, 3 were retreated with 2 achieving combined remission and 1 failing, 1 patient refused treatment due to good quality of life, and 1 showed delayed healing at 1-year follow-up. Overall success rate after rescue therapy reached 86.6% at final follow-up. Safety was maintained throughout all follow-up periods. The study demonstrates that patients achieving closure within 24 weeks sustained long-term response, and retreatment may be beneficial for non-responders. This represents the longest follow-up published trial on MFat injection for perianal Crohn's disease.