P523 Endoscopic balloon dilatation is safe and has a high success rate in patients with stricturing Crohn’s disease
Bibliographic record
Abstract
Stricturing Crohn’s disease (CD) is associated with significant morbidity and high rates of surgery with anastomotic strictures commonly occurring after surgery. Endoscopic balloon dilatation (EBD) may avoid or delay operative management of strictures. A retrospective audit of CD patients undergoing EBD was conducted at 11 hospitals across Australia and New Zealand. Local, prospectively maintained patient databases and procedure records were used to identify cases from June 1999 to October 2018. A stricture was defined as a narrow segment of intestine unable to be traversed with a colonoscope. Stricture length (long ≥4 cm, short <4 cm), location (ileal, ileocolonic, colonic, anorectal) and type (anastomotic vs. de novo) were collected from endoscopy reports. Dates of surgeries and follow-up were obtained from medical records. Technical success was defined as the ability to traverse the stricture following dilatation. Baseline smoking status, Montreal phenotype and medications for CD were also documented. A total of 236 patients with stricturing CD were identified (120 male, median age 48 [IQR: 10], 29% ileal, 12% colonic, 59% ileocolonic). A total of 620 dilatation procedures (303 for anastomotic strictures, 312 for de novo strictures, 5 unknown) were performed (median 2 per patient) with 428 (69%) on short strictures, 109 (18%) on long strictures, and 83 (13%) of unknown length. Balloon dilation diameter was 8 mm–20 mm (median 15 mm). Technical success was achieved in 433 (84%) of dilatations, and was significantly higher for short vs. long strictures (93% vs. 66%, p < 0.001). Technical success was lower in ileal strictures (72%) than colonic or ileocolonic strictures (89% and 85%, respectively, p = 0.002). End-to-end anastomosis had a numerically higher success rate (85% vs. 75%, p = 0.19). During the median follow-up time from first EBD to last review or surgery (50 months, [IQR: 30]), 55 patients (23%) required surgery for stricturing CD post-dilatation. The median time to surgery following the last dilatation was 8 months (range 0–90 months). Complications of EBD included 3 cases of perforation and two cases of aspiration. There was no major bleeding or procedure-related mortality identified. In one of the largest analyses of EBD for CD strictures, EBD is found to be a safe procedure with a high technical success rate overall. The highest success was observed in strictures less than 4 cm in length and non-ileal in location. EBD may be an effective strategy for avoiding surgery in stricturing Crohn’s disease and post-operative anastomotic strictures.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".