This article is more than 5 years old. Information may no longer be current.
Risk model for ileocecal resection includes imaging features, age
Younger patients with stricturing or penetrating Crohn’s disease at the terminal ileum might be candidates to immediate surgery rather than prolonged medical treatment, according to study results.
Amy L. Lightner, MD, an associate professor of surgery and associate chief of surgical research at Cleveland Clinic, and colleagues wrote that some patients have such severe disease that medical therapy will not be able to reverse mucosal damage caused by CD.
“Ultimately, over half of patients with CD require surgical intervention,” they wrote. “However, predicting which patients will require surgery remains difficult, complicating the decision on whether to proceed to surgery or escalate medical management at the time of outpatient consultation.”
To develop a risk score to predict ileocecal resection at 1 year, researchers conducted a retrospective study comprising 559 patients who had imaging findings of terminal ileal CD on computed tomography or magnetic resonance enterography between Jan. 1, and Dec. 21, 2016. They used Montreal classification — B1, inflammatory predominant; B2, stricturing; or B3, penetrating — to stratify patients and determined risk for ileocecal resection at 6 months and 1 year, as well as risk factors associated with surgery.
Overall, 121 patients underwent resection over the course of 1.4 years of follow-up (interquartile range, 0.21–1.64 years). At 6 months, the risk for resection was 18.2% (95% CI, 14.7%–21.6%), and at 1 year, it was 20.5% (95% CI, 16.8%–24.1%).
Lightner and colleagues based their risk score on several factors that they found were associated with increased likelihood of ileocecal resection. First, was Montreal classification (B2, HR = 2.73; B3, HR = 6.8; both, P < .0001). Next was upstream bowel dilation (HR = 3.06; P < .0001), followed by younger age (19–29 years reference; 30–44 years, HR = 0.83, P = .4; 45–59 years, HR = 0.58, P = .04; and 60+ years, HR = 0.45 P = .01).
Lightner and colleagues wrote that younger patients with stricture or penetrating findings have significant surgical risk within the next year.
“Such patients may elect to proceed to surgery quickly rather than rely on repeated medical regimens,” they wrote. “Our herein suggested nomogram is an easy tool to implement at the time of a clinic visit and should thus be considered as an adjunct in decision-making considering clinical presentation by the time of imaging.” – by Alex Young
Disclosures: Lightner reports receiving consulting fees for Takeda. All other authors report no relevant financial disclosures.