Risk Stratification for Surgery in Stricturing Ileal Crohn’s Disease: The BACARDI Risk Model

Bossuyt, Peter; Debeuckelaere, Celine; Ferrante, Marc; Overstraeten, Anthony de Buck van; Vanbeckevoort, Dirk; Billiet, Thomas; Wolthuis, Albert; Cleynen, Isabelle; Assche, Gert Van; D’Hoore, André; Vermeire, Séverine

doi:10.1093/ecco-jcc/jjx110

Cited by 37 publications

(25 citation statements)

References 31 publications

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“…The success rate of these EBD procedures was 84%, and the long-term prevention of surgery following EBD was 67.2%. These findings in agreement with success rates, [6,10,11] and surgery free survival [12–14] reported by others. Two recent meta-analyses reported an 89% technical success rate of EBD procedures among CD patients.…”

Section: Discussionsupporting

confidence: 92%

Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Winder

Fliss-Isakov²,

Winder³

et al. 2019

Medicine

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Intestinal strictures are common complications of Crohn's disease (CD). Endoscopic balloon dilatation (EBD) constitutes an alternative therapy to surgery, but associated factors of procedure success are inconclusive. Therefore, we aimed to evaluate the EBD success rate and its associated factors in CD patients.This is a retrospective cohort study of consecutive EBDs that were conducted between 2006 and 2014 among patients with CD with lower gastrointestinal tract strictures. Patients’ and stricture characteristics, short term procedure success and related complications at 1 week follow-up, and long-term clinical endpoints were documented.A total of 138 dilatations were performed on 64 CD patients. The overall dilatation success rate was 84.8%, with no difference between primary or anastomotic strictures, or between first or recurrent dilatation procedures. Long strictures (≥4 cm) were negatively associated with successful EBDs, but not with perforations. A multivariate analysis adjusting for age, sex, smoking, and disease duration revealed that a maximal dilatation diameter of ≥15 mm was positively associated with a successful EBD, while an inflamed stricture was negatively associated with procedure success. Strictures which were both long and inflamed were associated with the lowest EBD success rates compared with other strictures. Only 32.8% of patients required surgery during the follow-up period. Long-term prevention of surgery was negatively associated with stricture length and with a successful EBD.EBD is highly successful in treating intestinal strictures and in prevention of surgery in CD patients. Although EBD of long strictures is safe, it will not prevent surgery in the majority of cases.

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Section: Discussionsupporting

confidence: 92%

Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Winder

Fliss-Isakov²,

Winder³

et al. 2019

Medicine

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“…In general, the behavior of CD at diagnosis has been identified as an independent risk factor for early surgery. Particularly, in ileal CD with stricture, prestenotic dilatation, CRP, combined penetrating behavior, exposure to biologics, and presence of NOD2 rs2066844 risk allele are all significantly associated with an increased risk of surgery [33]. However, no study has been performed using machine learning techniques to develop prediction models regarding surgery risk using combined clinical and genetic data.…”

Section: Discussionmentioning

confidence: 99%

Development of a Clinical and Genetic Prediction Model for Early Intestinal Resection in Patients with Crohn’s Disease: Results from the IMPACT Study

Kang

Jang

Choi

et al. 2021

JCM

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Early intestinal resection in patients with Crohn’s disease (CD) is necessary due to a severe and complicating disease course. Herein, we aim to predict which patients with CD need early intestinal resection within 3 years of diagnosis, according to a tree-based machine learning technique. The single-nucleotide polymorphism (SNP) genotype data for 337 CD patients recruited from 15 hospitals were typed using the Korea Biobank Array. For external validation, an additional 126 CD patients were genotyped. The predictive model was trained using the 102 candidate SNPs and seven sets of clinical information (age, sex, cigarette smoking, disease location, disease behavior, upper gastrointestinal involvement, and perianal disease) by employing a tree-based machine learning method (CatBoost). The importance of each feature was measured using the Shapley Additive Explanations (SHAP) model. The final model comprised two clinical parameters (age and disease behavior) and four SNPs (rs28785174, rs60532570, rs13056955, and rs7660164). The combined clinical–genetic model predicted early surgery more accurately than a clinical-only model in both internal (area under the receiver operating characteristic (AUROC), 0.878 vs. 0.782; n = 51; p < 0.001) and external validation (AUROC, 0.836 vs. 0.805; n = 126; p < 0.001). Identification of genetic polymorphisms and clinical features enhanced the prediction of early intestinal resection in patients with CD.

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“…We have demonstrated that stricturing Crohn's disease is associated with a high morbidity, with almost half (46%) of all patients having surgery, often within a few months of stricture diagnosis. Historic cohorts, with strictures identified using a variety of techniques and with variable follow‐up, have reported a 50–70% surgical rate over 10 years …”

Section: Discussionmentioning

confidence: 99%

“…In a recent study, Bossuyt et al . developed the “BACARDI” risk model for stratifying patients with Crohn's strictures . This model included clinical, radiological, and genetic risk factors.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance enterography for predicting the clinical course of Crohn's disease strictures

Schulberg

Wright

Holt

et al. 2019

J of Gastro and Hepatol

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Background and Aims Strictures are the most common Crohn's disease complication, but their natural history is unknown. This study aimed to characterize inflammation, predict prognosis, and understand the impact of drug therapy using magnetic resonance enterography (MRE). Methods Patients with a stricture diagnosed on MRE over a 5‐year period were reviewed for MRE disease extent and inflammation, clinical course, C‐reactive protein, response to anti‐TNF therapy, endoscopic dilatation, hospitalization, and surgery. Results 136 patients had 235 strictures (77, one and 59, ≥ 2 strictures). Treatment: 46% of patients underwent surgery after a median 6 months; median follow‐up for those not requiring surgery was 41 months. Predictors of surgery: Hospitalization because of obstruction predicted subsequent surgery (OR 2.50; 95% CI 1.06–5.90) while anti‐TNF therapy commenced at stricture diagnosis was associated with a reduced risk (OR 0.23; 95% CI 0.05–0.99). MRE characteristics associated with surgery were proximal bowel dilatation ≥ 30‐mm diameter (OR 2.98; 95% CI 1.36–6.55), stricture bowel wall thickness ≥ 10‐mm (OR 2.42; 95% CI 1.11–5.27), and stricture length > 5‐cm (OR 2.56; 95% CI 1.21–5.43). 81% of patients with these three adverse MRE features required surgery versus 17% if none were present (P < 0.001). Accuracy for these three MRE variables predicting surgery was high (AUC 0.76). Conclusion Magnetic resonance enterography findings in Crohn's disease strictures are highly predictive of the disease course and the need for future surgery. MRE may also identify who would benefit from treatment intensification. Anti‐TNF therapy is associated with reduced risk of surgery and appears to alter the natural history of this complication.

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Risk Stratification for Surgery in Stricturing Ileal Crohn’s Disease: The BACARDI Risk Model

Abstract: This risk model can facilitate therapeutic decisions in IS-CD and suggest the correct time for surgery in daily clinical practice.

Cited by 37 publications

References 31 publications

Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Clinical outcomes of endoscopic balloon dilatation of intestinal strictures in patients with Crohn's disease

Development of a Clinical and Genetic Prediction Model for Early Intestinal Resection in Patients with Crohn’s Disease: Results from the IMPACT Study

Magnetic resonance enterography for predicting the clinical course of Crohn's disease strictures

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