A127 ANTI-TNF VS SURGICAL MANAGEMENT OF ABDOMINAL PHLEGMON IN CROHN’S DISEASE: A RETROSPECTIVE ANALYSIS
Notice bibliographique
Résumé
Penetrating Crohn’s disease (CD) can lead to the development of abdominal phlegmon and abscesses. Phlegmon formation can be addressed with antibiotic therapy, percutaneous drainage, or surgical resection. The role of anti-tumor necrosis factor (anti-TNF) treatment in this scenario is less well established. In particular, it is not clear how anti-TNF therapy affects need for surgical resection. Penetrating Crohn’s disease (CD) can lead to the development of abdominal phlegmon and abscesses. Phlegmon formation can be addressed with antibiotic therapy, percutaneous drainage, or surgical resection. The role of anti-tumor necrosis factor (anti-TNF) treatment in this scenario is less well established. In particular, it is not clear how anti-TNF therapy affects need for surgical resection. A retrospective chart review was conducted of all CD patients over age 18 presenting with abdominal phlegmon or abscess between the years 2000 and 2017 at Mount Sinai Hospital. Patients were excluded if the clinical record was incomplete or they lacked follow up, had perianal or post-operative phlegmon/abscess, or had greater than 2 previous intestinal resections or prior anti-TNF exposure. Patient demographics, treatment history, need for and timing of surgery (and any post-operative complications) were extracted and statistical analyses performed. Seventy cases of abdominal phlegmon complicating CD meeting inclusion/exclusion criteria were identified. Mean age at CD diagnosis was 21.2 years and average disease duration at phlegmon presentation was 10.5 years. Of 70 cases, initial treatment in 8 (11.4%) involved antibiotics alone, 50 (71.4%) received antibiotics followed by surgical resection within a period of 5.2 months, and 12 (17.1%) received antibiotics followed by anti-TNF. Of those who had first-line anti-TNF, 7 out of 12 (58.3%) went on to require surgery within an average follow up of 5.0 years, while 12 out of 50 (24.0%) of those who had first-line surgery went on to receive anti-TNF therapy within an average follow up of 8.6 years. Thus, patients who received first-line anti-TNF were significantly more likely to require a second intervention than those who had first-line surgery (58.3% vs. 24.0%, P=0.02). Surgical complications were not significantly different between those who did and did not receive pre-operative anti-TNF (28.6% vs. 12.2%, P=0.25). In the management of Crohn’s patients with abdominal phlegmon, our data suggests that while pre-operative anti-TNF therapy is safe and may delay surgical intervention, its use does not obviate the need for surgery altogether. None
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,003 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».