PTU-091 Right hemicolectomy in crohn’s disease – are we following ECCO guidelines?
Bibliographic record
Abstract
Introduction Despite recent advances in medical therapy, approximately 80% of patients with Crohn’s disease will require surgery within 20 years of diagnosis. Surgery is not curative and clinical and/or endoscopic recurrence occurs in the majority of patients. Correct pre-operative planning and post-operative care has a major impact on the outcome of such treatment. The aim of this study was to compare local practice in the Countess of Chester Hospital with published ECCO guidelines, to identify opportunities to improve care. Methods This was a retrospective analysis of all patients with Crohn’s disease that underwent a right hemicolectomy between January 2013 and December 2017 at the Countess of Chester Hospital. Patients were identified by obtaining a list of right-hemicolectomy specimens from the histopathology department. Patient notes were reviewed to ascertain patient demographics, pre- and post-operative treatment, and follow-up endoscopy. Results A total of 14 patients were identified for this study. Age range was 2–5 with a male to female ratio of 4:3. The Montreal classification varied widely. Only 8/14 (57%) of patients had received an immunomodulator pre-operatively and 2/14 (14%) were on a biologic. 10/14 (71%) of patients were not given either an immunomodulator or biologic post-operatively. Follow-up endoscopy occurred in 7/14 (50%) patients. 3 of these were within 6 months and 4 were within 12 months of the operation date. 3/7 (42.9%) of patients had evidence of recurrence on endoscopy. None of the patients had a Rutgeerts’ score generated. Conclusions This study demonstrates the variability of management of patients with Crohn’s disease post-operatively. Our results show that over 60% of patients were not on any medical treatment pre-operatively. In addition, over 75% of patients continued to remain on no maintenance after their operation. Only 50% of patients underwent a follow-up endoscopy within 12 months of their operation date and a Rugeerts’ score was not generated in any of these patients.
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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 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.005 | 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".