Massive continuous irrigation (MCI) and endoscopic debridement as an alternative treatment strategy for refractory abscess‐fistula complexes

Objective To evaluate the feasibility, safety, and efficacy of massive continuous irrigation (MCI) and endoscopic debridement for the treatment of refractory abscess–fistula complexes. Methods This was a retrospective single‐center observational study involving 12 patients with refractory abscess–fistula complexes. All patients had experienced long‐term treatment failure or had failed multiple treatment modalities. We used over two catheters and inserted them via the gastrointestinal (GI) tract or percutaneously to form a circulation pathway to achieve MCI of normal saline, endoscopic debridement was then performed. The treatment success rate, irrigation volume and treatment duration, time to abscess–fistula complex closure, intra‐treatment complications, and recurrence rate were recorded. Results The treatment success rates were 100%. The median time of previous treatment was 32 days (range 7–912 days). The mean time from the use of the novel treatment strategy to abscess–fistula complex healing was 18.8 ± 11.0 days. The mean volume of irrigation was 10 804 ± 1669 mL/24 h. The mean irrigation time was 16.5 ± 9.2 days, and a median of two irrigation tubes (range 2–5) were used. No complications occurred either during or after the procedure. During the follow‐up of 23.1 ± 18.1 months, no recurrence or adverse events were noted. Conclusions MCI and endoscopic debridement may be a feasible, safe, and effective alternative treatment for refractory abscess–fistula complexes. Large prospective studies are needed to validate our results.