Failure to Dilate Intestinal Strictures to Greater Than 16 mm Is Predictive of Future Surgery in Crohnʼs Disease
Bibliographic record
Abstract
Introduction: Crohn's disease (CD) related intestinal strictures can be managed with endoscopic balloon dilation in many circumstances to spare further intestinal resection. Our objective was to determine factors predictive of durable avoidance of future intestinal resection in CD related strictures treated with balloon dilation. Methods: A retrospective chart review of patients with Crohn's disease undergoing outpatient elective colonoscopy for therapeutic balloon dilation of intestinal strictures between 2005-2013 was performed. Patients with indeterminate colitis, malignant strictures, and anorectal strictures were excluded from the analysis. Demographics, CD surgical history, CD medication use, stricture characteristics (de novo, location), and dilation characteristics were extracted. The primary outcome was surgical resection of the treated stricture within 3 years of initial dilation. Kaplan-Meier curves using the life table method and Cox regression were performed using SAS 9.3.Table 1: Cox Proportional Hazard Regression of Surgery Within Three Years of Endoscopic Balloon DilationResults: Of 111 subjects identified, 25 (22.5%) underwent surgical resection within 3 years. Montreal phenotype classification, history of fistulizing disease (48.9% vs. 62.0%, p=0.177), prior surgery (67.4% vs. 68%, p=0.958), and smoking (34.9% vs. 44.0%, p=0.484) did not differ between those avoiding or undergoing surgery. Thiopurine and anti-TNF medication use did not differ between those avoiding and undergoing surgery. On univariate analysis, those avoiding surgery trended towards being more likely to have de novo strictures (43.0% vs. 28.0%, p=0.077), and had larger maximal dilation (16.13+/- 2.83mm vs. 14.28 +/- 3.30mm, p=0.017) compared to those undergoing surgery. Adjusting for demographics, disease characteristics, medication use, and stricture and dilation characteristics, failure achieve stricture dilation of at least 16mm (HR 7.98, 95%CI 2.09, 30.53) and prednisone use of 20mg or more (HR 4.55, 95%CI 1.10,18.87) were associated with and increased hazard of future surgery. Stricture location, de novo status, smoking status, and laboratory values (including CRP and albumin) were not significantly associated with surgical risk. Conclusion: This data suggests that stricture dilations less than 16mm are less likely to provide durable relief from stricture related symptoms and subsequent surgery. Beyond the limits of retrospective studies, non-standardized decision making to pursue endoscopic dilation or surgery demonstrate the need for prospective studies to confirm these results.
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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 | 0.002 |
| 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 | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 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 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".