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Short-term anti-TNF therapy with surgical closure versus anti-TNF therapy in the treatment of perianal fistulas in Crohn’s disease (PISA-II): a patient preference randomised trial.

Meima-van Praag LM, van Rijn KL, Wasmann KAT, Snijder H, Stoker J, D’Haens GR et al.

Lancet Gastroenterol Hepatol 2022; 7: 617-626.

Some 95 patients were included in this trial. After 18 months, radiological (MRI) healing was higher after surgery with anti-TNF (32 per cent) than anti-TNF alone (9 per cent); P=0.005. In contrast, clinical closure rates were reported as similar: 68 versus 52 per cent, respectively.

Comment: Shouldn’t there have been a surgery only arm for the perfect trial?

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