DOP77 Is durable remission achievable after ileocolic resection for Crohn’s disease ? Long-term results of a prospective multicentric cohort study of the GETAID Chirurgie
Bibliographic record
Abstract
Abstract Background Most of the patients undergoing bowel resection for Crohn’s disease (CD) develop postoperative recurrence requiring medical treatment intensification or surgery. Is there a subgroup of patients for which surgery allows durable remission? Methods In this retrospective follow-up study, we collected data from 592 patients undergoing ileocolic resection for CD who were included from 2013 to 2015 in a prospective nation-wide cohort of the GETAID Chirurgie group. Patients with follow-up superior to 36 months were included. Primary outcome was durable remission, defined as the absence of endoscopic recurrence (Rutgeerts ≥i2) and/or absence of medical treatment intensification. Uni- and multivariate analyses of the predictive factors for durable remission were carried out. Results Among 268 included patients, 158 (59%) had a B2 stricturing phenotype, 92 (34%) had a B3 penetrating phenotype and 18 (7%) had a non-stricturing non-perforating phenotype (Montreal classification). One hundred and eighty-eight patients (70%) had a primary ileocolic resection. One hundred and sixty-seven patients (66%) had postoperative medical treatment to prevent postoperative recurrence (Table 1). After a median follow-up of 85 (36-104) months, 52 patients (19%) had a durable remission, among which 24 (46%) had no medical treatment and 28 (54%) maintained the same postoperative prophylactic treatment, including anti-TNF therapy in 15 patients (54%) (Table 2). Durable remission rate was significantly increased in B1 phenotype vs B2/B3 (n=7/18 ;39% vs n=45/250; 18%, p=0.030) and in primary ileocolic resection vs redo ileocolic resection (n=43/184 ; 23% vs n=9/80 ; 11%, p=0.023). In multivariate analysis, B1 phenotype was an independent predictive factor for durable remission (OR=3.59, IC95%[1.13-11.37], p=0.030) (Table 3). Conclusion These long-term data obtained from a nation-wide prospective cohort are in line with those of a randomised controlled trial (LIR!C) and show that durable remission is obtained in nearly 40% of CD patients with non-stricturing non-penetrating phenotype operated for CD refractory to medical treatment. This important result should be considered when medical treatment intensification versus surgery is discussed in 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 | 0.002 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 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".