P0237Pre-Stenotic Dilation on Computed Tomography and Magnetic Resonance Enterography Is a Predictor Of Clinical Outcomes In Small Bowel Crohn’s Disease

Abstract Background Crohn’s disease (CD) terminal ileal strictures commonly lead to obstruction, hospitalization, and surgery. Pre-stenotic dilation (PSD), a hallmark feature of ileal strictures on computed tomography (CT) and magnetic resonance enterography (MRE), has been shown to predict the need for surgical intervention1,2. Surgical risk with PSD 3cm for CD ileal strictures on MRE is reported to be between 19.2%3 to 46%4 over a median of 5 years of follow up. Understanding the natural history from the time of PSD detection is important to inform management. This study evaluates the risk of CD-related hospitalization and surgical intervention for patients with small bowel CD strictures and index PSD up to a period of over 10 years. We aim to evaluate the risk of for CD patients with small bowel strictures and PSD on index MRE or CT. Methods Patients with ileal Crohn’s disease strictures and PSD on MRE or CT were identified from a University of Calgary CD database. Charts were reviewed retrospectively to determine the initial instance of PSD on CT/MRE denoted as the index scan. Baseline characteristics were summarized using medians (IQR) for continuous variables and counts (percentages) for categorical variables. Receiver operating characteristic (ROC) curve analysis identified optimal PSD cutoffs for predicting surgery and hospitalization, and time-to-event outcomes were analyzed using Kaplan–Meier curves Results Seventy-two ileal CD stricture patients with PSD on index MRE/CT were identified between 2008 to 2023 with a median (IQR) PSD of 2.5cm (1.8-3.3) over median duration follow up of 3.6 years. Of these patients, 23.9% (17) required stricture surgery and 26.4% (17) required CD-related hospitalization within a median of 21.5 months (14-58) and 10.5 months (5-66), respectively. ROC analysis identified PSD cutoffs of 2.97 cm (Sensitivity: 0.94, Specificity: 0.84) for predicting surgery and 2.57 cm for CD hospitalization (Sensitivity: 0.88, Specificity: 0.69). The hazard ratio for CD-related surgery was 10.2 (95% CI 1.30–80.6, p = 0.027), and 5.7 for hospitalization (95% CI 1.2–26.1, p = 0.025) for strictures with PSD ≥2.5 cm. Bowel wall thickness (BWT) was also found to be significantly higher in patients who underwent surgery (median 11mm vs. 6 mm; Wilcoxon rank-sum W = 46.5, p = 0.028). Conclusion An index pre-stenotic dilation of ≥ 2.5 cm on CT and MRE in CD small bowel strictures is predictive of CD-related surgery within 2 years, and hospitalization within 1 year. Quantitative assessment of pre-stenotic dilation on cross-sectional imaging can guide risk stratification and inform clinical and surgical management. References: 1. Stidham RW, Guentner AS, Ruma JL, et al. Intestinal Dilation and Platelet:Albumin Ratio Are Predictors of Surgery in Stricturing Small Bowel Crohn’s Disease. Clin. Gastroenterol. Hepatol. 2016;14:1112-1119.e2. 2. Okazaki N, Inokuchi T, Hiraoka S, et al. Findings of Retrograde Contrast Study Through Double-balloon Enteroscopy Predict the Risk of Bowel Resections in Patients with Crohnʼs Disease with Small Bowel Stenosis: Inflamm. Bowel Dis. 2017;23:2097–2103. 3. Dane B, Qian K, Krieger R, Smereka P, Foster J, Huang C, Chang S, Kim S. Correlation between imaging findings on outpatient MR enterography (MRE) in adult patients with Crohn disease and progression to surgery within 5 years. Abdom Radiol (NY). 2022;47(10):3424-3435. 4. Schulberg JD, Wright EK, Holt BA, et al. Magnetic resonance enterography for predicting the clinical course of Crohn’s disease strictures. J Gastroenterol Hepatol. 2020;35(6):980-987. Conflict of interest: O’Brien, Maureen: I have nothing to disclose. Reji, Rohita: No conflict of interest Rosentreter, Ryan: No conflict of interest Aldarwish, Alia: No conflict of interest Besney, Jonathan: No conflict of interest Ingram, Richard James Michael: Consultancy fees: AbbVie, Amgen, CellTrion, Eli Lilly, J & J Innovative Medicine, Pfizer, Sanofi, Takeda Pharmaceuticals. Speakers’ honoraria: AbbVie, Amgen, BioJAMP, Eli Lilly, Pfizer, Takeda Pharmaceuticals. Stocks: AbbVie, Eli Lilly, Merck (discretionary managed). Kaplan, Gilaad: Grant: Dr. Kaplan received grants for research from Ferring and for educational activities from AbbVie, Bristol Myers Squibb, Ferring, Fresenius-Kabi, Janssen, Pfizer, Takeda. Personal Fees: Dr. Kaplan has received honoraria for speaking or consultancy from AbbVie, Amgen, Janssen, Pfizer, and Takeda. Ma, Christopher: Consulting fees: AbbVie, Alimentiv, Amgen, Anaptys Bio, AVIR Pharma Inc, Bristol Myers Squibb, Celltrion, Domain Therapeutics, Eupraxia, Eli Lilly, Ferring, Forte Biosciences, Fresenius Kabi, Gilead, Janssen, McKesson, Merck, Mirador Therapeutics, Pendopharm, Pfizer, Roche, Sanofi, Takeda, Tillotts Pharma Speaker’s fees: AbbVie, Amgen, AVIR Pharma Inc, Alimentiv, Bristol Myers Squibb, Eli Lilly, Ferring, Fresenius Kabi, Janssen, Merck, Organon, Pendopharm, Pfizer, Sanofi, Takeda, Tillotts Pharma Royalties: Springer Publishing Research Support: AbbVie, Eli Lilly, Ferring, Pfizer Novak, Kerri L.: Research Grants: Helmsley Trust, Pfizer, Janssen Adboard, consulting fees: Abbvie, Janssen, Pfizer, Pendopharm, Takeda, Elli Lilly, Celltrion, Bristal Myers Non financial support (ultrasound machine) McKesson Pharmcy. Pfizer, Celltrion Panaccione, Remo: Grant: Abbvie, Janssen, Pfizer, Takeda Other: Consultant for: Abbott, AbbVie, Abbivax, Alimentiv (formerly Robarts), Amgen, AnaptysBio, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Celltrion, Cosmos Pharmaceuticals, Eisai, Elan, Eli Lilly, Ferring, Galapagos, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pendopharm, Pfizer, Progenity, Prometheus Biosciences, Protagonist Therapeutics, Roche, Sandoz, Satisfai Health, Shire, Sublimity Therapeutics, Spyre Therapeutics, Takeda Pharmaceuticals, Theravance Biopharma, Trellus, Union Biopharma, Viatris, Ventyx, UCB Speaker’s Fees for: AbbVie, Amgen, Arena Pharmaceuticals, Bristol-Myers Squibb, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Gilead Sciences, Janssen, Merck, Organon, Pfizer, Roche, Sandoz, Shire, Takeda Pharmaceuticals Advisory Boards for: AbbVie, Alimentiv (formerly Robarts), Amgen, Arena Pharmaceuticals, AstraZeneca, Biogen, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, Eli Lilly, Ferring, Fresenius Kabi, Genentech, Gilead Sciences, Glaxo-Smith Kline, JAMP Bio, Janssen, Merck, Mylan, Novartis, Oppilan Pharma, Organon, Pandion Pharma, Pfizer, Progenity, Protagonist Therapeutics, Roche, SandozShire, Sublimity Therapeutics, Takeda Pharmaceuticals, Ventyx. Seow, Cynthia: Reports advisory boards for Janssen, Abbvie, Takeda, Lilly, Ferring, Shire, Pfizer, Sandoz, Pharmascience, Fresenius Kabi, Amgen, Bristol Myers Squibb, and Celltrion and speaker for Janssen, Abbvie, Takeda, Lilly Ferring, Shire, Pfizer, Pharmascience, and Fresenius Kabi. St-Pierre, Joelle: Consultant for Pfizer, Abbvie, Eli Lilly and Pendopharm, and speaker for Takeda. Rieder, Florian: Personal Fees: Adiso, Adnovate, Agomab, Allergan, AbbVie, Arena, Astra Zeneca, Boehringer-Ingelheim, Celgene/BMS, Celltrion, CDISC, Celsius, Cowen, Ferring, Galapagos, Galmed, Genentech, Gilead, Gossamer, Granite, Guidepoint, Helmsley, Horizon Therapeutics, Image Analysis Limited, Index Pharma, Landos, Jannsen, Koutif, Mestag, Metacrine, Mopac, Morphic, Organovo, Origo, Palisade, Pfizer, Pliant, Prometheus Biosciences, Receptos, RedX, Roche, Samsung, Sanofi, Surmodics, Surrozen, Takeda, Techlab, Teva, Theravance, Thetis, UCB, Ysios, 89Bio Dr. Lu, Cathy: Advisory board - Abbvie, Johnson and Johnson, Takeda, Ferring, Merck, Celltrion, Lilly, Pfizer, Pendopharm, Agomab. Research Funding - Abbvie, Helmsley Charitable Trust, Alberta Innovates