title: Conventional Versus Biological Therapy for Prevention of Postoperative Endoscopic Recurrence in Patients With Crohn's Disease: an International, Multicenter, and Observational Study.
abstract: OBJECTIVE
  Postoperative endoscopic recurrence (PER) occurs in nearly 80% of patients 1 year after ileocecal resection in patients with Crohn's disease (CD). Biological agents were more effective in reducing the rates of PER in comparison with conventional therapy, in prospective trials. The aim of this study was to compare the PER rates of biological versus conventional therapy after ileocecal resections in patients with CD in real-world practice.
  
  
  METHODS
  The MULTIPER (Multicenter International Postoperative Endoscopic Recurrence) database is a retrospective analysis of PER rates in CD patients after ileocecal resection, from 7 referral centers in 3 different countries. All consecutive patients who underwent ileocecal resections between 2008 and 2012 and in whom colonoscopies had been performed up to 12 months after surgery, were included. Recurrence was defined as Rutgeerts' score ≥i2. The patients were allocated to either biological or conventional therapy after surgery, and PER rates were compared between the groups.
  
  
  RESULTS
  Initially, 231 patients were evaluated, and 63 were excluded. Of the 168 patients in the database, 96 received anti-tumor necrosis factor agents and 72 were treated with conventional therapy after resection. The groups were comparable regarding age, gender, and perianal disease. There was longer disease duration, more previous resections, and more open surgical procedures in patients on biologicals postoperatively. PER was identified in 25/96 (26%) patients on biological therapy and in 24/72 (33.3%) patients on conventional therapy (P=0.310).
  
  
  CONCLUSIONS
  In this retrospective observational analysis from an international database, no difference was observed between biological and conventional therapy in preventing PER after ileocecal resections in CD patients.
authors.affiliation: Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, PR, Brazil.
authors.forename: Paulo Gustavo
authors.initials: PG
authors.lastname: Kotze
authors.affiliation: Colorectal and IBD Surgery Unit, Humanitas Research Hospital, University of Milan, Milan, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Spinelli
authors.affiliation: Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, PR, Brazil.
authors.forename: Rodolff Nunes
authors.initials: RN
authors.lastname: da Silva
authors.affiliation: Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, PR, Brazil.
authors.forename: Ivan Folchini
authors.initials: IF
authors.lastname: de Barcelos
authors.affiliation: Clínica Gastrosaúde, Marília, SP, Brazil.
authors.forename: Fábio Vieira
authors.initials: FV
authors.lastname: Teixeira
authors.affiliation: Digestive Surgery Unit, Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil.
authors.forename: Rogério
authors.initials: R
authors.lastname: Saad-Hossne
authors.affiliation: Inflammatory Bowel Disease Outpatient Clinic, Heliópolis Hospital, São Paulo, SP, Brazil.
authors.forename: Idblan Carvalho
authors.initials: IC
authors.lastname: de Albuquerque
authors.affiliation: Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, PR, Brazil.
authors.forename: Marcia
authors.initials: M
authors.lastname: Olandoski
authors.affiliation: Colorectal Surgery Unit, Catholic University of Paraná, Curitiba, PR, Brazil.
authors.forename: Lorete Maria
authors.initials: LM
authors.lastname: da Silva Kotze
authors.affiliation: Gastroenterology Unit, Sakura Hospital, Toho University, Chiba, Japan.
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: Gastroenterology Unit, Sakura Hospital, Toho University, Chiba, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Yamada
authors.affiliation: Gastroenterology Unit, Sakura Hospital, Toho University, Chiba, Japan.
authors.forename: Ken
authors.initials: K
authors.lastname: Takeuchi
authors.affiliation: Colorectal and IBD Surgery Unit, Humanitas Research Hospital, University of Milan, Milan, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Sacchi
authors.affiliation: Inflammatory Bowel Disease Centre, Yokkaichi Hazu Medical Centre, Yokkaichi, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yamamoto
keywords: Crohn disease; Recurrence; Tumor necrosis factor-alpha