P158 Short-term MRE predictors of need in Crohn's disease related surgery
O. Shchukina*1, V. Sobco2, D. Gorbacheva3, V. Grigorian4, A. Karpenko5
1North-Western state medical university named after I.I. Mechnikov, Department of Gastroenterology and Dietology, St-Petersburg, Russian Federation, 2Consultative-diagnostic center with the polyclinic” of the Department of affairs management of President of Russian Federation, Consultative-diagnostic center with the polyclinic” of the Department of affairs management of President of Russian Federation, St-Petersburg, Russian Federation, 3City clinical hospital №31, Centre of diagnostic and treatment IBD patient in St.-Petersburg St-Petersburg, Russian Federation, 4The First Pavlov State Medical University of St. Peterburg, The First Pavlov State Medical University of St. Peterburg, St-Petersburg, Russian Federation, 5“Consultative-diagnostic center with the polyclinic” of the Department of affairs management of President of Russian Federation, “Consultative-diagnostic center with the polyclinic” of the Department of affairs management of President of Russian Federation, St-Petersburg, Russian Federation
Background
Most patients with Crohn's disease (CD) during follow-up period and at diagnosis require surgery. Verification of predictors that can estimate the risk of need for surgical treatment is important to optimize the treatment policy. MRE signs may act as the predictors of the need for CD surgical treatment during the short-term observation and an unfavorable outcome.
The aim of the study was determine specific MRE signs that can help to predict the risk of the need for surgical treatment in the following year-long clinical observation.
Methods
Patients with CD were chosen from prospective and maintained registry of City IBD centre (St.-Petersburg) from May 2007 to May 2014. They underwent MR enterografy on magnetic resonance tomograph with a capacity of 1.5 T magnetic field. Each segment of the small and large bowel were evaluated.
The need for CD- related surgical resection, 1 month after the MRE during 12 month follow-up period was an endpoint. Specific MRE signs correlated with the endpoint. Acceptance of anti-TNF was an exclusion criterion .
In the frames of statistical analysis Methods of variance analysis, Student's t-test and the tabulation of conjugation with the counting statistics Chi-square were used. The regression analysis was used to determine the probability of surgery.
Results
During the MRE observation was conducted for 134 CD patients. Among them 10 patients were operated during the year (average time before surgery 5,5 month). The need for surgical treatment was considered as unfavorable CD outcome.
More common features for operated patients in the analysis of the overall MRE significantly are: dilated small bowel loops (p=0,0001, OR: 12,78, CI 3,11-52,5), fibro-fatty proliferation (p=0,0023, OR: 8,00 CI 1,94 - 32,98), inflammatory reaction of mesentery (p=0,0004, OR: 15,84; CI3,16 - 79,27 engorged mesenteric vessels (p=0,0143,OR: 11,29; CI 1,39 - 91,85), stricture (p=0,0466, OR: 5,08 CI 1,25 - 20.72 ) , fistulas (p=0,0005, OR: 14,5 CI 3,47 - 60,7), abscess in ileo-cecum (p=0,0002, OR: 11 78 CI 2,96 - 46,94), lesions of the colon (p=0,0126, OR: 5,24; CI).
More than that MRE signs were connected with the risk of resection obtained during evaluating of the terminal ileum and the ascending portion of the colon/
Odds ratio for corresponding MRI features are shown in figure 1, 2.
*p<0.05 **p<0.01 ***p<0.001
*p<0.05
**p<0.01
***p<0.001
Conclusion
MRE signs may act as the predictors of the need for CD surgical treatment during the short-term observation and an unfavorable outcome.