S1643 Virtual EUA Boosts Clinical Confidence in Complex Perianal Crohn’s Disease

Introduction: Pelvic MRI is the gold standard for assessing perianal Crohn's disease, but interpretation can be challenging for non-radiologists. Virtual Examination under Anesthesia (vEUA) is a novel technology that generates a 3D model to enhance evaluation of fistula anatomy by demarcating the fistula tract in relation to the anal canal and pelvis. This multi-center observational study aims to assess the attitudes of gastroenterologists and surgeons toward this novel MRI technology. Methods: A panel of gastroenterologists and surgeons reviewed two cases of perianal Crohn's disease and then completed a set of standardized questionnaires. The first case had a trans-sphincteric tract with two internal openings. The second case had a more complicated trans-sphincteric fistula with tracts extending above the puborectalis muscle. For each case, participants were provided with a 3D vEUA model and a written report drafted by a radiologist. Participants first reviewed the narrative report and then completed a survey assessing confidence in understanding pathology, clinical decision-making, and ability to provide patient education based on the report. The survey was then repeated after viewing the vEUA model. Results: Of 50 responses, 23 (46%) were gastroenterologists and 27 (54%) were surgeons. Amongst these, 17 (34%) were trainees. All scores increased significantly after viewing the vEUA model, there was a 19% improvement for case 1 (MD 1.33 ± 1.71 points P < 0.001) and a 28% improvement for case 2 (MD 2.16 ± 1.88 points P < 0.001). The largest increases were seen in understanding anatomy (P < 0.001) and supporting operative planning (P < 0.05) for case 2. Gastroenterologists demonstrated greater improvements over surgeons in understanding fistula anatomy (P < 0.01) and overall decision making (P = 0.01) for case 1. Trainees demonstrated larger improvement in understanding fistula anatomy (<0.001) and overall clinical decision making (<0.005). Free text comments were received from 16 participants; 11 (69%) favored the vEUA model and 5 (31%) were neutral. Conclusion: vEUA allows for improved evaluation of fistula anatomy by demarcating the fistula tract and its branches. Gastroenterologists and surgeons, especially trainees, found it helpful for understanding anatomy and guiding management, notably with greater benefit in the more complex case.