Evidence map›Paper›PMID 40205247›Full record

SynthesisTechniques in coloproctology2025

Systematic review and meta-analysis of the efficacy and safety of stem cell treatment of anal fistulas.

S H Emile, J Dourado, P Rogers, A Wignakumar, N Horesh, Z Garoufalia, S D Wexner

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Techniques in coloproctology, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Article
  2. Review
  3. Platelet-rich fibrin matrix as treatment for complex anal fistulae: A 3-year experience at a tertiary centre.Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland · 2026
    Article
  4. Article
  5. Review
  6. Article
  7. Article
  8. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

S H EmileEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
J DouradoEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
P RogersEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
A WignakumarEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
N HoreshEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
Z GaroufaliaEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA.
S D WexnerEllen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd., Weston, FL, 33331, USA. wexners@ccf.org.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundSince anal fistulas can be challenging to treat; numerous innovative treatments have been proposed, including stem cell therapy. This systematic review aimed to assess pooled rates of fistula healing and adverse events associated with stem cell treatment.

methodsIn this PRISMA-compliant systematic review we searched PubMed and Scopus for observational and randomized studies reporting outcomes of stem cell treatment for anal fistulas. The main outcome measures were successful healing and adverse effects of stem cell therapy.

resultsIn total, 43 studies incorporating 1160 patients (53.6% male) were included. Underlying fistula etiologies were Crohn's disease (30 studies) and cryptoglandular disease (12 studies). The main origin of stem cells was from adipose tissue (34 studies) or bone marrow (6 studies). The median follow-up duration was 12 months. The combined overall pooled healing rate was 58.1% (95% confidence interval (CI) 51.5-64.7%). The pooled healing rate for Crohn's fistulas was 60.4% (95% CI 54.7-66.2%) with adipose-derived stem cells and 63.6% (95% CI 49.4-77.7%) with bone-marrow-derived cells. The pooled healing rate for cryptoglandular fistulas was 53.8% (95% CI 35.5-72.2%) with adipose-derived stem cells. The pooled complication rate was 37.3% (95% CI 27.1-47.5%). Stem cells were associated with higher odds of anal fistula healing (odds ratio (OR): 1.81, p = 0.003) and similar odds of complications (OR: 1, p = 0.986) compared with controls.

conclusionsStem cell treatment of anal fistulas was associated with promising results. The healing rate in Crohn's anal fistulas was higher than in cryptoglandular fistulas. Bone-marrow-derived stem cells were associated with marginally better outcomes than were adipose-derived cells. This finding suggests that the autoimmune inflammatory etiology of Crohn's disease may respond better to autologous myoblasts than does the infectious etiology of cryptoglandular fistulas.

Indexed as

Rectal FistulaStem Cell TransplantationAdipose TissueAdultCrohn DiseaseFemaleHumansMaleMiddle AgedRandomized Controlled Trials as TopicTreatment OutcomeWound HealingAdverse effectsAnal fistulasHealingStem cellsSystematic review

Identifiers

PMID40205247
PMCPMC11982159

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.