A127 ANTI-TNF VS SURGICAL MANAGEMENT OF ABDOMINAL PHLEGMON IN CROHN’S DISEASE: A RETROSPECTIVE ANALYSIS
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".