Editorial: Imaging and the treatment of Crohn's perianal fistulas: to see is to believe.

Abstract

Fistulizing Crohn's disease is associated with significant morbidity. Although treatment has improved over the last decade, there is still considerable room for improvement. One possible method to improve outcomes is to use advanced imaging techniques, such as endoscopic ultrasound (EUS) or magnetic resonance imaging (MRI), to help guide treatment. In this issue, Ng et al. show again the disconnect between cessation of drainage and the actual deep healing that can be appreciated using these imaging techniques. The authors used MRI to help guide the decision on when to alter medical therapy and were able to identify a subset of patients who could discontinue infliximab. Other authors over the last 5-10 years have also shown the benefit of EUS and MRI in these patients. The time has come for us to not only embrace these imaging modalities as valid end points for clinical trials but more importantly as a means to improve outcomes for our patients with fistulizing Crohn's disease.