title: Factors associated with surgery in patients with intra-abdominal fistulizing Crohn's disease.
abstract: OBJECTIVE
  To characterize radiological and clinical factors associated with subsequent surgical intervention in Crohn's disease (CD) patients with intra-abdominal fistulae.
  
  
  METHODS
  From a cohort of 1244 CD patients seen over an eight year period (2006 to 2014), 126 patients were identified as having intra-abdominal fistulae, and included in the study. Baseline patient information was collected from the medical records. Imaging studies were assessed for: anatomic type and number of fistulae; diameter of the inflammatory conglomerate; length of diseased bowel; presence of a stricture with pre-stenotic dilatation; presence of an abscess; lymphadenopathy; and the degree of bowel enhancement. Multivariate analysis for the prediction of abdominal surgery was calculatedviaGeneralized Linear Models.
  
  
  RESULTS
  In total, there were 193 fistulae in 132 patients, the majority (52%) being entero-enteric. Fifty-nine (47%) patients underwent surgery within one year of the imaging study, of which 36 (29%) underwent surgery within one month. Radiologic features that were associated with subsequent surgery included: multiple fistulae (P= 0.009), presence of stricture (P= 0.02), and an entero-vesical fistula (P= 0.01). Evidence of an abscess, lymphadenopathy, or intense bowel enhancement as well as C-reactive protein levels was not associated with an increased rate of surgery. Patients who were treated after the imaging study with combination immunomodulatory and anti-TNF therapy had significantly lower rates of surgery (P= 0.01). In the multivariate analysis, presence of a stricture [RR 4.5 (1.23-16.3),P= 0.02] was the only factor that increased surgery rate.
  
  
  CONCLUSIONS
  A bowel stricture is the only factor predicting an increased rate of surgery. Radiological parameters may guide in selecting treatment options in patients with fistulizing CD.
authors.affiliation: Shaul Yaari, Ariel Benson, Eyal Aviran, Ran Oren, Eran Israeli, IBD Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Shaul
authors.initials: S
authors.lastname: Yaari
authors.affiliation: Shaul Yaari, Ariel Benson, Eyal Aviran, Ran Oren, Eran Israeli, IBD Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Benson
authors.affiliation: Shaul Yaari, Ariel Benson, Eyal Aviran, Ran Oren, Eran Israeli, IBD Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Eyal
authors.initials: E
authors.lastname: Aviran
authors.affiliation: Shaul Yaari, Ariel Benson, Eyal Aviran, Ran Oren, Eran Israeli, IBD Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Naama
authors.initials: N
authors.lastname: Lev Cohain
authors.affiliation: Shaul Yaari, Ariel Benson, Eyal Aviran, Ran Oren, Eran Israeli, IBD Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Ran
authors.initials: R
authors.lastname: Oren
authors.affiliation: Shaul Yaari, Ariel Benson, Eyal Aviran, Ran Oren, Eran Israeli, IBD Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Jacob
authors.initials: J
authors.lastname: Sosna
authors.affiliation: Shaul Yaari, Ariel Benson, Eyal Aviran, Ran Oren, Eran Israeli, IBD Unit, Institute of Gastroenterology and Liver Diseases, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
authors.forename: Eran
authors.initials: E
authors.lastname: Israeli
mesh_terms: D000293:Adolescent; D000328:Adult; D003424:Crohn Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D006801:Humans; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D018579:Patient Selection; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D061665:Time-to-Treatment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
keywords: Computed tomography-scan; Crohn’s disease; Cross-sectional imaging; Fistula; Intra-abdominal surgery; Magnetic resonance imaging