Development of an Objective Model to Define Near-Term Risk of Ileocecal Resection in Patients with Terminal Ileal Crohn Disease.

Details

Serval ID
serval:BIB_8DB59C46AAA0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Development of an Objective Model to Define Near-Term Risk of Ileocecal Resection in Patients with Terminal Ileal Crohn Disease.
Journal
Inflammatory bowel diseases
Author(s)
Grass F., Fletcher J.G., Alsughayer A., Petersen M., Bruining D.H., Bartlett D.J., Mathis K.L., Lightner A.L.
ISSN
1536-4844 (Electronic)
ISSN-L
1078-0998
Publication state
Published
Issued date
18/10/2019
Peer-reviewed
Oui
Volume
25
Number
11
Pages
1845-1853
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
The decision to either escalate medical therapy or proceed to ileocecal resection (ICR) in patients with terminal ileal Crohn disease (CD) remains largely subjective. We sought to develop a risk score for predicting ICR at 1 year from computed tomography or magnetic resonance enterography (CTE/MRE).
We conducted a retrospective cohort study including all consecutive adult (> 18 years) patients with imaging findings of terminal ileal CD (Montreal classification: B1, inflammatory predominant; B2, stricturing; or B3, penetrating) on CTE/MRE between January 1, 2016, and December 31, 2016. The risk for ICR at 6 months and at 1 year of CTE/MRE and risk factors associated with ICR, including demographics, CD-specific immunosuppressive therapeutics, and disease presentation at the time of imaging, were determined.
Of 559 patients, 121 (21.6%) underwent ICR during follow-up (1.4 years [IQR 0.21-1.64 years]); the risk for ICR at 6 months and at 1 year was 18.2% (95% CI 14.7%-21.6%) and 20.5% (95% CI 16.8%-24.1%), respectively. Multivariable analysis revealed Montreal classification (B2, hazard ratio [HR] 2.73, and B3, HR 6.80, both P < 0.0001), upstream bowel dilation (HR 3.06, P < 0.0001), and younger age (19-29 years reference, 30-44 years, HR 0.83 [P = 0.40]; 45-59 years, HR 0.58 [P = 0.04], and 60+ years, HR 0.45 [P = 0.01]) to significantly increase the likelihood of ICR. A predictive nomogram for interval ICR was developed based on these significant variables.
The presence of CD strictures, penetrating complications, and upstream bowel dilation on CTE/MRE, combined with young age, significantly predict ICR. The suggested risk model may facilitate objective therapeutic decision-making.
Keywords
Adolescent, Adult, Colectomy/adverse effects, Constriction, Pathologic/diagnostic imaging, Constriction, Pathologic/etiology, Crohn Disease/complications, Crohn Disease/diagnostic imaging, Crohn Disease/surgery, Dilatation, Pathologic/diagnostic imaging, Dilatation, Pathologic/etiology, Female, Humans, Ileum/pathology, Logistic Models, Magnetic Resonance Imaging, Male, Middle Aged, Models, Statistical, Multivariate Analysis, Retrospective Studies, Risk Assessment/methods, Risk Factors, Tomography, X-Ray Computed, Young Adult, Crohn disease, ileocecal resection, imaging, stricturing
Pubmed
Web of science
Create date
29/11/2021 13:52
Last modification date
30/11/2021 6:39
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