{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T22:22:40Z","timestamp":1792794160491,"version":"4.5.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T00:00:00Z","timestamp":1657497600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"University of Ottawa Department of Medicine","id":[{"id":"https:\/\/ror.org\/03c4mmv16","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Multidisciplinary care involving exam under anesthesia (EUA) and tumor necrosis factor (TNF) inhibitors is recommended for perianal Crohn\u2019s disease. However, the impact of this combined approach is not well established.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a comparative cohort study between 2009 and 2019. Patients with perianal Crohn\u2019s disease treated with EUA before anti-TNF therapy (combined modality therapy) were compared with anti-TNF alone. The primary outcome was fistula closure assessed clinically. Secondary outcomes included subsequent local surgery and fecal diversion. Multivariable analysis adjusted for abscesses, concomitant immunomodulators, and time to anti-TNF initiation was performed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Anti-TNF treatment was initiated 188 times in 155 distinct patients: 66 (35%) after EUA. Abscesses (50% vs 15%; P &amp;lt; .001) and concomitant immunomodulators (64% vs 50%; P = .07) were more common in the combined modality group, while age, smoking status, disease duration, and intestinal disease location were not significantly different. Combined modality therapy was not associated with higher rates of fistula closure at 3 (adjusted odds ratio [aOR], 0.7; 95% confidence interval [CI], 0.3-1.8), 6 (aOR, 0.8; 95% CI, 0.4-2.0) and 12 (aOR, 1.0; 95% CI, 0.4-2.2) months. After a median follow-up of 4.6 (interquartile range, 5.95; 2.23-8.18) years, combined therapy was associated with subsequent local surgical intervention (adjusted hazard ratio, 2.2; 95% CI, 1.3-3.6) but not with fecal diversion (adjusted hazard ratio, 1.3; 95% CI, 0.45-3.9). Results remained consistent when excluding patients with abscesses and prior biologic failure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>EUA before anti-TNF therapy was not associated with improved clinical outcomes compared with anti-TNF therapy alone, suggesting that EUA may not be universally required. Future prospective studies controlling for fistula severity are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ibd\/izac143","type":"journal-article","created":{"date-parts":[[2022,7,11]],"date-time":"2022-07-11T06:42:37Z","timestamp":1657521757000},"page":"763-770","source":"Crossref","is-referenced-by-count":5,"title":["Examination Under Anesthesia May Not Be Universally Required Prior to Anti-TNF Therapy in Perianal Crohn\u2019s Disease: A Comparative Cohort Study"],"prefix":"10.1093","volume":"29","author":[{"given":"Melissa","family":"Chan","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5411-1430","authenticated-orcid":false,"given":"Moses","family":"Fung","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Chin Koon Siw","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Ottawa , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reena","family":"Khanna","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Western Ontario , London, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"de Buck van Overstraeten","sequence":"additional","affiliation":[{"name":"Department of Surgery, Mount Sinai Hospital, University of Toronto , Toronto, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elham","family":"Sabri","sequence":"additional","affiliation":[{"name":"Ottawa Hospital Research Institute , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey D","family":"McCurdy","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine, University of Ottawa , Ottawa, ON , Canada"},{"name":"Ottawa Hospital Research Institute , Ottawa, ON , Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,7,11]]},"reference":[{"key":"2023050208151050300_CIT0001","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1053\/gast.2002.32362","article-title":"The natural history of fistulizing Crohn\u2019s disease in Olmsted County, Minnesota.","volume":"122","author":"Schwartz","year":"2002","journal-title":"Gastroenterology"},{"issue":"1","key":"2023050208151050300_CIT0002","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1093\/ecco-jcc\/jjaa118","article-title":"The incidence and disease course of perianal Crohn\u2019s disease: a Danish nationwide cohort study, 1997-2015","volume":"15","author":"Wewer","year":"2020","journal-title":"J Crohns Colitis."},{"issue":"12","key":"2023050208151050300_CIT0003","first-page":"1392","article-title":"Significant medical and surgical morbidity in perianal Crohn\u2019s disease: results from a territory-wide study.","volume":"12","author":"Yan Mak","year":"2018","journal-title":"J Crohns Colitis."},{"issue":"6","key":"2023050208151050300_CIT0004","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1093\/ibd\/izy329","article-title":"update on the natural course of fistulizing perianal Crohn\u2019s disease in a population-based cohort","volume":"25","author":"Park","year":"2019","journal-title":"Inflamm Bowel Dis."},{"issue":"3","key":"2023050208151050300_CIT0005","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.gtc.2017.05.003","article-title":"Loftus EV Jr. Epidemiology, natural history, and risk stratification of Crohn\u2019s 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