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The experts say: “I-PDT therapy is safe, secure, reproducible and has encouraging results in the healing of the fistulas”

Interview with Dr. Antonio Arroyo. Specialist in Surgery and Gastroenterology. (University Hospital of Elche, Spain)

Dr. Antonio Arroyo, an expert in the use of intralesional photodynamic therapy, I-PDT, in anal fistulas, explains his experience with this technique at the University Hospital of Elche (Spain).

What is a complex fistula and where does the complexity lie in the treatment of this pathology?
Anal fistula is a connection inside the anus with the outer skin. The aetiology of anal fistulas is not definitively clarified but it is assumed to occur as a result of an infection of the anal glands, due to its high prevalence. These formations are located in the anal canal at the level of the pectinate line. Its inner orifice is at the level of the crypts of Morgagni. According to this hypothesis, the infection of these glands by enteric bacteria results in the formation of an abscess that can spread through the different areas of the anal canal, appearing when they are drained or when opened spontaneously to the external orifice of fistulas. The problem is that these fistulas traverse the anal muscles that we use for fecal continence and any intervention thereon may be problematic.

What impact is there on the population?
The incidence rate of anal fistula is about 10/100,000. That is, it affects 10 out of every 100,000 people.

What is life like for people with this disease?
They have a very poor quality of life, with pus spots and faeces stains appearing daily on their underwear.

What is the conventional treatment for fistulas?
The classic surgical techniques – fistulectomy, with or without flaps, fistulectomy-sphincteroplasty and looping, employed as a means of drainage or cutting, “condemn” the patient to overall fecal incontinence rates of between 10% and 20%, with recurrence rates ranging from 20% to 40%.

And what is photodynamic laser therapy?
Photodynamic therapy (PT) is a therapeutic modality based on the photo-oxidation of biological materials induced by a photosensitizer, selectively localized in certain inflammatory cells or tumour tissues, so that when illuminated with a light of an appropriate wavelength of sufficient dose, such cells are destroyed.

What benefits does photodynamic laser therapy I-PDT offer in the treatment of fistulas?
This therapy produces a selective destruction of inflammatory fistulous tissue and causes a cure without damage to the surrounding tissues, thus preventing fecal incontinence which occurs with surgery.

What are the benefits to the patient from laser photodynamic therapy?
This therapy is harmless, safe, reproducible and offers encouraging results in the treatment of this pathology.

How is treatment with I-PDT performed?
Under spinal anesthesia, the fistulous tract is located and injected with the 5-ALA photosensitizer. Subsequently a 630 nm red laser light will be applied through a 1mm thick optical fibre (with an Multidiode™ 630 PDT, by INTERmedic Spain).

What effect does the laser have on the tissue?
The laser induces the destruction of the fistulous tissue, while preserving the healthy tissue.

The Elche Hospital is one of the first in which this technology is being used for fistulas, in a clinical trial. What results have been obtained so far?
The preliminary experience of a pilot project conducted in the Coloproctology Unit at the General University Hospital of Elche using this technique in 20 consecutive patients with complex anal fistula showed a cure rate of 80%, with a rate of incontinence of 0%.

How many sessions of I-PDT treatment are necessary to solve this condition?
So far there is only evidence of one single treatment session.

Are we talking about improvement or healing?
We’re talking about healing.

And in terms of cost, is this an affordable therapy, both for doctors and for patients?
A safe, secure therapy that cures 80% of fistulas without the complications of traditional surgery, I-PDT therapy is priceless.

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08-09-2016