P564 Surgical treatment of jejuno-ileal Crohn’s disease. Results from the The JejUno Ileal Crohn's disEase (JUICE) international, multicentric, observational study
Bibliographic record
Abstract
Abstract Background Crohn’s disease (CD) affecting the upper gastrointestinal (GI) tract is a rare condition, leading to a scarcity of information regarding its diagnosis, surgical treatment, and adjuvant therapy. The JUICE study aimed to conduct a surgical audit of duodeno-jejuno-ileal CD across 11 European IBD Referral Centres. Methods The study included all the consecutive, non-selected patients undergoing surgery for upper-GI CD between January 2010 and December 2022. Patients with synchronous ileal and colonic locations were included, while those with previous upper-GI CD surgery or multiple surgeries for ileo-colic CD were excluded. Univariate and multivariate analyses of 120 variables, covering pre-operative characteristics, intra-operative findings, and post-operative follow-up, were conducted. Results The study encompassed 279 patients, with a male/female ratio of 2.2. The average age at diagnosis was 30±14 years, and the disease duration was 11±10 years. The Montreal Classification revealed A1 15.4%, A2 61.3%, A3 23.3%; L1+L4 34.4%, L2+L4 4%, L3+L4 26.9%, isolated L4 34%; B1 1.8%, B2 67.4%, B3 30.8%; perianal location 19.4%. BMI averaged 21±3. Preoperative nutritional support was necessary in 50.5%. MRI-enterography was the predominant preoperative examination (86.7%). Comorbidities were present in 24.7%, with 61% having an ASA score >1. In the 30 days pre-surgery, 16.8% used steroids, 41.2% received biologicals, with 24.6% on combined (biologicals + steroids) therapy. Video-assisted approach was used in 70%, with a 5.1% conversion rate. Intraoperative staging revealed 1334 locations treated with 247 resections, 500 strictureplasties, 12 bypasses, and 53 concomitant colonic resections. Entero-enteric fistulas and intra-abdominal abscesses were present in 29% and 14%. Patients with thickened mesentery, wrapping fat, and lymph node enlargement were 50.8%, 38.7%, and 50.8%, respectively. Mortality was 1%, Clavien-Dindo grade 3 and 4 complication rate 11.1%. Hospital stay averaged 10±6 days; 90-day readmission was 3.2%. B3 behaviour, smoking, preoperative malnutrition, and preoperative biological therapy increased postoperative complication risk (p=0.01). 10-year Kaplan-Meier surgical recurrence rate was 23%, reduced to 11% with early and continuous post-op biologic treatment compared to late treatment or suspension (60% - Log-Rank p<0.0001). Conclusion This is by far the largest series of upper-GI CD ever studied, depicting a little known, complex, technically demanding sub-group of patients. Preoperative optimization, focusing on preoperative nutritional status and therapy, is crucial to reduce complication risk. Early-onset post-operative biological therapy seems to significantly reduce long-term surgical recurrence.
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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 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| 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".