Search

Background: Topical treatments and botulinum toxin injections are valid options for the management of patients with chronic anal fissures (CAF) but little is known about the efficacy in a long-term follow-up. The aim of this meta-analysis was evaluate the effectiveness, given to clinical outcomes of medical treatments in adults. Method: this manuscript was developed according to PRISMA [23, 25] and registered in PROSPERO (Registration number: CRD42020120386). A systematic literature search was conducted through MEDLINE, EMBASE, Web of Science, and Cochrane Library databases. Randomized control trials that compared medical treatment were identified; publications had to have a clinical definition of CAF with at least one of the following signs or symptoms: visible sphincter fibers at the base of the fissure, anal papillae, sentinel piles, and indurated margins. The symptoms had to be chronic for at least 4 weeks. Results: 17 randomized trials met the inclusion criteria. Diltiazem showed a superior effect compared with glycerin (RR = 1.16 [95% CI = 1.05-1.30]; I2 = 18%), and with fewer adverse effects (RR = 0.13 [95% CI = 0 , 04-0.042]; I2 = 87%). Similar results were evidenced with the use of nifedipine compared with lidocaine (RR = 4.53 [95% CI = 2.99-6.86]; I2 = 28%). Botulinum toxin did not show statistically significant differences compared to glycerin (RR = 0.81 [95% CI = 0.02-29.36]; I2 = 93%) or isosorbide dinitrate (RR = 1.45 [CI 95% = 0.32-6.54]; I2 = 85%). Regarding recurrence, nifedipine was superior to lidocain (RR = 0.18 [95% CI = 0.08-0.44]; I2 = 31%). Conclusions: Calcium channel blockers performed well regarding the healing of CAF when compared to others in long-term follow-up. The superiority of botulinum toxin was not evidenced compared to topical treatments. More studies are needed to better assess recurrence rates.