In the Journals

Radiographic features predict need to resect intraabdominal abscesses in Crohn’s

Using radiographic measures may help stratify patients to surgical or nonsurgical treatments for intraabdominal Crohn’s disease-related abscesses, according to study results.

Ryan Stidham, MD, MSc, of the University of Michigan School of Medicine, and colleagues wrote in Inflammatory Bowel Diseases that intraabdominal abscesses can be treated a number of ways, including surgical resection and non-surgical interventions like antimicrobial treatments and percutaneous drainage, but knowing which one to pick has been a challenge.

“Choosing between nonsurgical and surgical management is difficult as the desire to avoid bowel resection is judged against the seeming inevitability of surgery in 70% of reported cases,” they wrote. “We aimed to determine whether baseline clinical, therapeutic, and image-based abscess and disease features were associated with the avoidance of future surgery in patients with a nonoperatively managed intraabdominal abscess attributable to CD.”

Researchers performed a chart review in patients with CD who were hospitalized for abscess confirmed by imaging between 2008 and 2016 (n = 121). Each patient received nonoperative management with intravenous antibiotics at their index hospitalization and were followed for a minimum of 2 years.

Investigators collected radiographic disease features to see if any were associated with resection of the bowel segment involving the abscess within 2 years of their index hospitalization.

Stidham and colleagues found that most patients went on to require surgery, but more than a third were able to avoid it within those 2 years (36.4%).

In their analysis, they found that bowel wall thickness (HR = 3.08; 95% CI, 1.2–6.21), disease length (HR = 2.67; 95% CI, 1.4–6.2), bowel dilation (HR = 2.19; 95% CI, 1.02–4.68) and abscess greater than 6 cm in size (HR = 2.47, 95% CI, 1.17–5.21) were all independent risk factors for future surgery in patients who do not immediately undergo resection for abscess management.

Stidham and colleagues wrote that patients with these features might do better with either immediate surgery or surgery after antibiotic and drainage is optimized where appropriate.

“Together, this suggests radiologic findings aid decisions between attempting conservative abscess management alone or instead optimizing the patient and planning for near-term surgery,” they wrote. “Future work examining detailed image-based assessments of disease activity, including modern assessments of bowel wall characteristics to assess the degree of fibrostenotic features within the bowel wall, may improve the ability to predict the success of conservative abscess management outcomes or the inevitability of a surgical resection.” – by Alex Young

Disclosures: Stidham reports being a consultant for AbbVie, Janssen and Merck. Please see the full study for all other authors’ relevant financial disclosures.

Using radiographic measures may help stratify patients to surgical or nonsurgical treatments for intraabdominal Crohn’s disease-related abscesses, according to study results.

Ryan Stidham, MD, MSc, of the University of Michigan School of Medicine, and colleagues wrote in Inflammatory Bowel Diseases that intraabdominal abscesses can be treated a number of ways, including surgical resection and non-surgical interventions like antimicrobial treatments and percutaneous drainage, but knowing which one to pick has been a challenge.

“Choosing between nonsurgical and surgical management is difficult as the desire to avoid bowel resection is judged against the seeming inevitability of surgery in 70% of reported cases,” they wrote. “We aimed to determine whether baseline clinical, therapeutic, and image-based abscess and disease features were associated with the avoidance of future surgery in patients with a nonoperatively managed intraabdominal abscess attributable to CD.”

Researchers performed a chart review in patients with CD who were hospitalized for abscess confirmed by imaging between 2008 and 2016 (n = 121). Each patient received nonoperative management with intravenous antibiotics at their index hospitalization and were followed for a minimum of 2 years.

Investigators collected radiographic disease features to see if any were associated with resection of the bowel segment involving the abscess within 2 years of their index hospitalization.

Stidham and colleagues found that most patients went on to require surgery, but more than a third were able to avoid it within those 2 years (36.4%).

In their analysis, they found that bowel wall thickness (HR = 3.08; 95% CI, 1.2–6.21), disease length (HR = 2.67; 95% CI, 1.4–6.2), bowel dilation (HR = 2.19; 95% CI, 1.02–4.68) and abscess greater than 6 cm in size (HR = 2.47, 95% CI, 1.17–5.21) were all independent risk factors for future surgery in patients who do not immediately undergo resection for abscess management.

Stidham and colleagues wrote that patients with these features might do better with either immediate surgery or surgery after antibiotic and drainage is optimized where appropriate.

“Together, this suggests radiologic findings aid decisions between attempting conservative abscess management alone or instead optimizing the patient and planning for near-term surgery,” they wrote. “Future work examining detailed image-based assessments of disease activity, including modern assessments of bowel wall characteristics to assess the degree of fibrostenotic features within the bowel wall, may improve the ability to predict the success of conservative abscess management outcomes or the inevitability of a surgical resection.” – by Alex Young

Disclosures: Stidham reports being a consultant for AbbVie, Janssen and Merck. Please see the full study for all other authors’ relevant financial disclosures.