A clinical and radiographic model to predict surgery for acute small bowel obstruction in Crohn’s disease

Lowe, Sarina C.; Ream, Justin; Hudesman, David; Malter, Lisa; Bosworth, Brian; Xia, Yuhe; Zhong, Judy; Dane, Bari; Megibow, Alec J.; Chang, Shannon

doi:10.1007/s00261-020-02514-6

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…In that study however, heterogenous stricture definitions were used, only adalimumab was allowed as a therapy, specified outcomes were different and images were not centrally evaluated. Increased stricture length was also associated with surgery in other studies 14,22 . Importantly, stricture length has recently been found to be measurable in a highly reliable manner, making this risk factor for intervention broadly applicable 25 …”

Section: Discussionmentioning

confidence: 82%

“…The limitations of our study include the observational nature of the study and the limited number of patients (albeit comparable to other published studies of this kind) 5,7–9,11,22 as well as non‐protocolized medical treatments. However, these patients were a well‐defined group treated according to currently accepted standards of care in a quaternary care IBD center and outcomes seen here likely reflect outcomes that can be expected in “real‐world” practice.…”

Section: Discussionmentioning

confidence: 94%

“…18 the lack of central reading. 4,14,22,23 The importance of central reading has previously been demonstrated for endoscopy and histopathology. 24 Our study addresses these gaps by including a well-defined population from a prospectively-maintained registry using a consensual stricture definition, with central reading and validation of results.…”

Section: Discussionmentioning

confidence: 95%

“…Increased stricture length was also associated with surgery in other studies. 14,22 Importantly, stricture length has recently been found to be measurable in a highly reliable manner, making this risk factor for intervention broadly applicable. 25 In our study, the number of obstructive symptoms was associated with the need for intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Our study is the first to describe the rate of progression and risk factors of stricturing CD using the new criteria. Other limitations in the available literature include the inclusion of mixed populations, the lack of validation of predictors, inclusion of patients with pre‐existing internal penetrating disease, the presence of multifocal strictures (including colonic strictures) and the lack of central reading 4,14,22,23 . The importance of central reading has previously been demonstrated for endoscopy and histopathology 24 .…”

Section: Discussionmentioning

confidence: 99%

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Validation of stricture length, duration and obstructive symptoms as predictors for intervention in ileal stricturing Crohn's disease

et al. 2022

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Background Risk factors for intervention in terminal ileal (TI) stricturing Crohn's disease (CD) are poorly defined. Novel and rigorous definitions for TI strictures recently became available. Objective We aimed to describe the rates of symptoms or need for endoscopic balloon dilation (EBD) or surgery as well as risk factors of progression in a well‐defined stricturing CD cohort. Methods Consecutive adult patients with non‐penetrating stricturing TI CD, as defined by centrally‐read magnetic resonance enterography CONSTRICT criteria, were separated into a derivation and validation cohort. Clinical and imaging characteristics were collected following prespecified scoring conventions. Primary outcome was a composite endpoint of EBD or surgery (“intervention”). Multivariable analysis was performed. Results Eighty‐six patients (48.8% female, median age 36 years) met selection criteria, 17.4% had prior EBD, 59.3% previously received biologics and 58.1% of strictures were anastomotic. Median follow‐up was 63.4 [95% CI: 57, 68.9] months. In the derivation cohort, at 12 and 48 months, 26% and 45% of patients had intervention, respectively. Multivariable analysis showed obstructive symptoms (Hazard ratio [HR] 1.444; 95% CI 1.126–1.852), stricture duration (HR 0.974; 95% CI, 0.954–0.995) and length (HR 1.039; 95% CI, 1.011–1.069) predicted intervention. The concordance index for split‐sample validation was 0.74 and 0.67, respectively. Biologics were not associated with intervention. An online risk calculator was constructed. Conclusion In patients with TI stricturing CD, 26% and 45% required intervention at 1 and 4 years. Obstructive symptoms, stricture duration and length were independent and validated predictors of the need for intervention. These findings are important for clinical practice and aid in the design of future trials for CD strictures.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 94%