Multi-disciplinary teams for Crohn's disease: Who should be presented?

Abstract

Background: Multi-disciplinary team (MDT) conferences are used within the realm of colorectal surgery for both benign and malignant disease to assist in both diagnostic workup and to guide treatment. Usually, teams encompass colorectal surgery (CRS), gastroenterology (GE), pathology and radiology. Although it is believed that MDT discussion is associated with improved outcomes, there is a scarcity of evidence regarding the benefit or patient selection criteria among patients with inflammatory bowel disease (IBD). Due to advancements in both medical and surgical management in the management of IBD, clinical decision making may be challenging. Our aim is to identify which patients are currently being presented in MDT meetings and to assess compliance with the MDT's recommendations.

Methods: We conducted a retrospective, observational, multiple campus study including all patients with Crohn's Disease (CD) treated within our system during a twelve-month period. Data was collected from a prospective database of MDT patients and retrospective chart review, including demographics, medical and surgical history, disease course and treatment provided. We compared patients presented at MDT to patients without conference review. Outcomes considered included medical versus surgical management. Analysis included chi square and student t-test, with p < 0.05 considered statistically significant.

Results: From September 2022 to September 2023, 766 patients were presented to our hospital system for management of CD disease and 52 patients were reviewed at a multi-disciplinary conference for IBD. On comparison of the two groups, those presented at the conferences were on average younger (43.4 vs. 44.9 years; p < 0.05) and had lower body mass index (BMI) compared to those not presented (23.6 vs. 26.1; p < 0.05). There was no difference in gender (p = 0.55) or race distribution between the two groups (p = 0.07). Surgical intervention was more frequent in patients that were presented in MDT meetings (46.2 % vs. 23.2 %; p < 0.05).

Conclusion: Multi-disciplinary conferences can be used in IBD and CD disease to guide treatment. Our results suggest a tendency to present younger, lower BMI patients for surgical management of CD disease. Further analysis will target the role of this conference in new diagnoses, in the setting of medical refractory disease or those with multiple prior operative interventions, and in patients who require additional consultants outside of gastroenterology and colorectal surgery. Prospective studies are warranted to establish criteria for presentation of CD Disease patients at MDT conferences.