S1173 Evaluating the Predictors of Endoscopic Balloon Dilation Failure, Success, and Surgery Prevention in Crohn's Disease-Related Strictures: A 15-Year Experience at a Tertiary Care Center
Notice bibliographique
Résumé
Introduction: Intestinal strictures affect one-third of individuals with Crohn’s disease (CD) within ten years of disease onset. Endoscopic balloon dilation (EBD) is a minimally invasive procedure for managing fibrostenotic strictures in patients with CD. Long-term outcomes after EBD are poorly defined in the literature. The aims of this study are to evaluate the efficacy of EBD in delaying surgery for the treatment of strictures in patients with CD and identify clinical, endoscopic, and stricture-related factors associated with avoidance of surgery after five years of EBD. Methods: Retrospective cohort study including all patients with CD undergoing EBD at a tertiary academic center between 01/2007-12/2021. Data for demographics, disease characteristics, stricture characteristics, surgical history, medication history, need for surgical intervention, time to surgical intervention, and need for re-dilation were collected. Patient outcomes were followed from their index dilation up to five years post dilation. Results: 378 patients with CD diagnosis (51% female) with a mean age 45 years underwent EBD during the study period (681 total dilations). The location of the stricture was upper gastrointestinal in 30 patients (9%), ileal (35%), colonic (13%), ileocolonic (44%) in other patients. Among these patients, 118 (31%) required surgery for CD-related stricture during the five-year follow-up periods. Prednisone therapy was a predictor for progression to surgery post-EBD (P=0.002). 156 patients (43%) required re-dilation. Patients with De Novo strictures were more likely to undergo surgery compared to those with anastomotic strictures (P=0.034). Eight patients (2%) had complications with three of those requiring surgery. Conclusion: This is one of the largest single-center studies looking at outcomes of EBD for treatment of CD-related strictures. 69% of patients treated with EBD avoided surgery within a five-year follow-up period. Steroid therapy was predictive of surgical resection within five years. Similar to current literature, anastomotic strictures had better outcomes than De Novo. Larger prospective studies are needed to confirm our results (Table 1). Table 1. - Patient characteristics, Montreal classification at time of dilation, steroid use, stricture characteristics, and response to endoscopic dilation All Patients (n=378) Surgery post-dilation (n=118) No surgery post-dilation (n=260) P-value Female, n(%) 194 (51%) 68 (58%) 126 (49%) 0.098 Race, n(%) 0.100 White 356 (94%) 112 (95%) 244 (94%) Black 17 (5%) 4 (3%) 13 (5%) Age at dilation (years), mean (sd) 30 (16) 31 (16) 29 (15) 0.158 BMI, mean (sd) 27 (7) 27 (6) 27 (7) 0.935 Age at Diagnosis 0.469 A1 (< 16 years) 70 (21%) 20 (18%) 59 (23%) A2 (17-40 years) 205 (56%) 67 (59%) 134 (54%) A3 ( >40 years) 84 (23%) 27 (24%) 57 (22%) Behavior of Disease, n(%) 0.013 Stricturing 269 (72%) 72 (61%) 197 (77%) Stricturing and Penetrating 105 (28%) 46 (39%) 59 (23%) Location, n(%) 0.228 L1 (Ileal) 131 (35%) 47 (40%) 84 (33%) L2 (Colonic) 50 (13%) 11 (9%) 39 (15%) L3 (Ileocolonic) 163 (44%) 52 (44%) 111 (43%) L4 (Upper GI) 30 (9%) 8 (7%) 22 (8%) Perianal Disease, n(%) 109 (29%) 43 (36%) 66 (25%) Prednisone at dilation, n(%) 60 (16%) 29 (25%) 31 (12%) 0.002 Endoscopic Severity at time dilation, n(%) 0.256 Remission 51 (14%) 12 (11%) 39 (15%) Mild 119 (32%) 34 (30%) 85 (23%) Moderate 119 (32%) 35 (31%) 84 (23%) Severe 83 (22%) 32 (28%) 51 (20%) Location of Stricture, n(%) 0.255 Ileum 105 (28%) 42 (46%) 63 (25%) Ileocolonic 174 (46%) 46 (39%) 128 (50%) Colonic 43 (11%) 12 (10%) 31 (12%) Upper GI 24 (6%) 7 (6%) 17 (7%) Jejunal 7 (2%) 3 (3%) 4 (2%) Anal 22 (6%) 8 (7%) 14 (5%) Stricture type, n(%) 0.034 De Novo 214 (57%) 76 (65%) 138 (53%) Anastomotic 162 (43%) 41 (35%) 121 (47%) Need for redilation, n(%) 156 (43%) 49 (42%) 107 (43%) 0.847
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 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 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 ».