Combination of colonoscopy and magnetic resonance enterography is more useful for clinical decision making than colonoscopy alone in patients with complicated Crohn's disease

Sagami, Shintaro; Kikkawa, Nao; Umeda, Satoko; Nakano, Masaaki; Toyonaga, Takahiko; Okabayashi, Shinji; Ozaki, Ryo; Hibi, Toshifumi

doi:10.1371/journal.pone.0212404

Cited by 10 publications

(5 citation statements)

References 39 publications

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“…However, no significant association was found between the inflammatory or fibrostenosing criteria in MRE and disease activity based on ileocolonoscopy. These findings differ from those in a retrospective study by Sagami et al, who reported a positive correlation between the SES-CD and the MaRIA scores in patients with inflammatory activity, while no correlation was found in individuals with fibrostenosing or penetrating disease [39]. Although our work presents a relatively small number of patients with exclusively proximal CD, these divergent findings in the literature may be due to a high incidence of terminal ileal disease in topography possibly not accessible by colonoscopy.…”

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confidence: 99%

Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns

Chinem

Esberard

Moreira

et al. 2019

Gastroenterology Research and Practice

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Background and Aims. Magnetic resonance enterography (MRE) has become an important modality of radiological imaging in the evaluation of Crohn’s disease (CD). The aim of this study was to investigate the impact of MRE in the assessment of disease activity and abdominal complications and in the making of therapeutic decisions for patients with CD. Methods. In a cross-sectional retrospective study, we selected 74 patients with CD who underwent MRE and ileocolonoscopy with an interval between the two exams of up to 30 days between January 2011 and December 2017. We assessed the parameters of the images obtained by MRE and investigated the agreement with the level of disease activity and complications determined by a clinical evaluation, inflammatory biomarkers, and endoscopy, as well as the resulting changes in medical and surgical management. Results. Changes in medical management were detected in 41.9% of patients. Significant changes in medical decisions were observed in individuals with a purely penetrating (P=.012) or a mixed (P=.024) MRE pattern. Patients with normal MRE patterns had a correlation with unchanged medical decisions (P=.001). There were statistically significant agreements between the absence of inflammatory criteria on MRE and remission according to the Harvey and Bradshaw index (HBI) (P=.037), the presence of inflammatory criteria on MRE and positive results for calprotectin (P=.005), and penetrating criteria on MRE and the scoring endoscopic system for Crohn’s disease (SES-CD), indicating active disease (P=.048). Finally, there was significant agreement between the presence of fibrostenotic criteria and a long disease duration (P=.027). Conclusion. MRE discloses disease activity and complications not apparent with other modalities and results in changes in therapeutic decisions. In addition to being used for diagnosis, MRE should be routinely used in the follow-up of CD patients.

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confidence: 99%

Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns

Chinem

Esberard

Moreira

et al. 2019

Gastroenterology Research and Practice

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“…Balloon-assisted endoscopy, in addition to MRE, may be beneficial if the patient has obstructive symptoms as indicated in statement 3.3 [ 185 ]. Unfortunately, in patients with stricturing disease, SES-CD based on conventional ileocolonoscopy does not correlate with MaRIA score nor does it predict the need for treatment escalation, [ 186 ]. This is likely because the stenosis prevents deep insertion of the scope for many patients, thereby limiting the ability of endoscopy to assess inflammation.…”

Section: Consensus Recommendationsmentioning

confidence: 99%

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

et al. 2023

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Background We aimed to develop criteria for treatment intensification in patients with (1) luminal Crohn’s disease (CD), (2) CD with perianal disease and/or fistula, (3) CD with small bowel stenosis, (4) in the postoperative setting, and (5) for discontinuing or reducing the dose of treatment in patients with CD. Methods PubMed and Embase were searched for studies published since 1998 which may be relevant to the five defined topics. Results were assessed for relevant studies, with preference given to data from randomized, controlled studies. For each question, a core panel of 12 gastroenterologists defined the treatment target and developed statements, based on the literature, current guidelines, and relevant additional studies. The evidence supporting each statement was graded using the Oxford Centre for Evidence-Based Medicine: Levels of Evidence (March 2009). A modified Delphi process was used to refine statements and gain agreement from 54 Japanese specialists at in-person and online meetings conducted between October 2020 and April 2021. Results Seventeen statements were developed for treatment intensification in luminal CD (targeting endoscopic remission), six statements for treatment intensification in perianal/fistulizing CD (targeting healing of perianal lesions and complete closure of the fistula), six statements for treatment intensification in CD with small bowel stenosis (targeting resolution of obstructive symptoms), seven statements for treatment intensification after surgery (targeting endoscopic remission), and five statements for discontinuing or reducing the dose of treatment in patients with CD. Conclusions These statements provide guidance on how and when to intensify or de-intensify treatment for a broad spectrum of patients with CD.

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“…57 In a retrospective study of 50 CD patients, MRE findings indicated the need for treatment modification in 24% of patients who had endoscopic remission defined by a SES-CD <5. 58 MRE can be used in diagnosing small bowel inflammation and as well as a prognostic tool for relapses, 59 therefore it has found its place in monitoring CD patients.…”

Section: Cross Sectional Imaging Monitoringmentioning

confidence: 99%

Pursuing therapeutic success in Crohn’s disease: A matter of definition, tools and longterm outcomes

et al. 2020

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Management of Crohn’s disease (CD) based on symptom control is a tale of the past as new treatment strategies aim toward a “treat to target” concept and to a patient-tailored approach. Defining treatment goals and assessing therapeutic success have been in the center of IBD research in the past years. Clinical remission and mucosal healing are well-established treatment goals by current recommendations, although prospective data is required to determine whether achieving these targets is enough to alter disease natural course. Furthermore, there is no standard in assessing therapeutic success. Low relapse and hospitalization rates, as well as a low need of surgery are indicators of a successful treatment. Close monitoring is part of the new therapeutic strategy. Monitoring tools are numerous, comprising clinical, biological, endoscopic and imaging scores or parameters but are far from being perfect. The traditional strategy of managing CD patients based on clinical symptoms and response to treatment did not improve the long-term outcomes. Clinical activity scores are frequently used in clinical trials and daily practice, but their use alone is not an accurate measure of inflammation. Endoscopic remission is associated with a lower risk of complications and a better long-term prognostic. Several guidelines include recommendations regarding surveillance endoscopy, but there is an open debate regarding the follow-up intervals. Cross-sectional imaging techniques play a complementary role in assessing transmural inflammation and in identifying extra-intestinal complications of CD and should be used in conjunction with endoscopy. Therapeutic drug monitoring is essential in assessing loss of response and making therapeutic decisions, although firm recommendations are not implemented into daily practice. Extraintestinal manifestations are often disregarded when discussing monitoring protocols. There is no current guideline indication for extraintestinal manifestations monitoring during remission periods.

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Combination of colonoscopy and magnetic resonance enterography is more useful for clinical decision making than colonoscopy alone in patients with complicated Crohn's disease

Cited by 10 publications

References 39 publications

Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns

Changes in the Management of Patients with Crohn’s Disease Based on Magnetic Resonance Enterography Patterns

Treatment escalation and de-escalation decisions in Crohn’s disease: Delphi consensus recommendations from Japan, 2021

Pursuing therapeutic success in Crohn’s disease: A matter of definition, tools and longterm outcomes

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