A217 OUTCOMES OF BALLOON ASSISTED ENDOSCOPIC STRICTURE DILATION IN PATIENTS WITH SMALL BOWEL CROHN’S DISEASE
Bibliographic record
Abstract
Abstract Background Crohn’s Disease (CD) is a subset of inflammatory bowel disease (IBD) that has unique pharmacologic, endoscopic and surgical considerations secondary to chronic, transmural inflammation that affects the entire gastrointestinal tract. The natural history of this disease is complicated by formation of fibro-stenotic strictures, adhesions and penetrating fistulae. Balloon-assisted endoscopy (BAE) has significantly improved the ability to assess and treat small bowel CD. Aims We present a Canadian cohort of patients that have undergone BAE for stricture dilation of fibrostenotic CD. We retrospectively analyzed demographic, clinical and endoscopic risk factors that could be associated with increased risk of requiring surgical management. Methods Retrospective analysis of 157 patients undergoing BAE for stricture dilation of known CD from Apr 2012 – Jan 2024 at the University of Alberta Hospital. A total of 282 procedures were performed and 629 strictures dilated. Patients were then subdivided into two groups: patients that required surgery at any point after their first BAE compared with patients managed with balloon-assisted endoscopic stricture dilation alone. Results Of 157 patients with confirmed stricturing CD, 65/157 (41.4%) required surgery between Apr 2012- Jan 2024 and 92/157 (58.6%) patients were managed with endoscopic intervention. The average age at the time of their first BAE was 55.9 years and mean disease duration was 20.76 years in the surgery group. Average patient age in the non-surgical group was 52 years and mean disease duration was 17.9 years. 43.08% (28/65) of patients were active smokers in the surgical group vs. 26.09% (24/92) in the non-surgical group. Concurrent or previous biologic use was comparable at 76.9% and 73.9% in the surgical and non-surgical groups, respectively. The average minimum diameter dilated was 15.2(+/- 0.25) mm in the surgical group vs. 16.2(+/- 0.16) mm in the non-surgical group. The incidence of non-traversable strictures post-dilation was higher in the surgical group (34/231, 14.72%) compared with the non-surgical group (16/398, 9.20%). In total, 97 surgeries were performed and average time to surgery from first BAE was 32.22 months (excluding emergent/urgent surgeries). Average time from most recent BAE to surgery was 8.79 months. There were 3 emergent surgeries (<24 hours from BAE to surgery, including one perforation) and 7 urgent surgeries (<30 days from BAE to surgery). Conclusions BAE has revolutionized endoscopic management of small bowel stricturing CD. Based on our retrospective case cohort, most patients with symptomatic strictures in the small bowel secondary to CD can be successfully managed with balloon-assisted endoscopic dilation. BAE may also play an important role in preventing emergent/unplanned surgical interventions. Funding Agencies None
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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 | 0.000 | 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 | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| 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".