Value of endoscopy and MRI for predicting intestinal surgery in patients with Crohn's disease in the era of biologics

Jauregui-Amezaga, A; Rimola, Jordi; Ordás, Íngrid; Rodríguez, Sónia; Ramírez‐Morros, Anna; Gállego, Marta; Masamunt, Maria Carme; Llach, Josep; González-Suárez, Begoña; Ricart, Elena; Panés, Julián

doi:10.1136/gutjnl-2014-308101

Cited by 76 publications

(49 citation statements)

References 19 publications

(16 reference statements)

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“…These results were consistent with a previous report, which documented the positive correlation between the pre-operative bowel wall thickness and the risk of recurrence following conservative surgery for CD [64]. As expected, the detection of stricturing and/or penetrating complications at both US and MRI has been linked to a reduced surgery-free survival over a 12-24 month follow-up [63,65]. More surprisingly, the previously documented association between severe endoscopic lesions and the risk of surgical resection has no longer been confirmed in more recent reports [65], so as to suggest that abdominal imaging may be more useful than colonoscopy in the risk stratification of CD patients in the biologic era.…”

Section: Prediction Of the Need For Surgery And Response To Medical Tsupporting

confidence: 93%

Evolving roles of cross-sectional imaging in Crohn's disease

Magarotto

Orlando

Coletta

et al. 2016

Digestive and Liver Disease

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Section: Prediction Of the Need For Surgery And Response To Medical Tsupporting

confidence: 93%

Evolving roles of cross-sectional imaging in Crohn's disease

Magarotto

Orlando

Coletta

et al. 2016

Digestive and Liver Disease

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“…Although ileocolonoscopy is generally considered the most accepted gold standard for assessing inflammatory lesions in CD patients, previous studies as well as the current study highlight important limitations [2,14,21]. Importantly, ten patients (23.25 %) had incomplete ileocolonoscopy due to severe stenosis or impossibility to intubate the terminal ileum but all of them were evaluated by MRE.…”

Section: Discussionmentioning

confidence: 77%

“…The accuracy of clinical assessment for the diagnosis of these complications is low [18,19], and endoscopy misses penetrating complications and, frequently, can only provide an incomplete assessment of stenosis. Both, penetrating and obstructive lesions represent independent predictors of risk for bowel resection surgery in patients with CD, even in subjects under biological therapy [20,21]. The inclusion of gadolinium sequences identified 11 patients with fistulas, whereas only 7 were detected by T2 sequences.…”

Section: Discussionmentioning

confidence: 99%

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

et al. 2016

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Background Magnetic resonance enterography (MRE) is an accurate examination for assessing activity in Crohn's disease (CD). Various MRE indices have been developed for that purpose, but have not been directly compared. The aim of the study was to compare the diagnostic accuracy of three MRE indices for detecting and grading disease activity in CD, using endoscopy as gold standard. Methods MRE and ileocolonoscopies performed within 1 month in 43 patients with CD were analyzed. The magnetic resonance index of activity (MaRIA), Clermont, and London indices for each colonic segment and the terminal ileum were calculated. Simplified endoscopy score for CD (SES-CD) was considered the gold standard. Results Two hundred and twenty-four intestinal segments were included in the analysis. According to the established cut-off points for detecting active disease using MaRIA, Clermont, and London indices, the sensitivity of each index was 0.88, 0.89, and 0.71, and the specificity was 0.97, 0.78, and 0.99, respectively. The sensitivity for detecting ulcerations was 0.90 and 0.83 for the MaRIA and Clermont indices, respectively, with a specificity of 0.91 and 0.89. The AUROC curve for the MaRIA, Clermont, and London indices for detecting active disease was 0.92, 0.84, and 0.85, and for detecting ulcerations was 0.90 for the MaRIA, and 0.86 for Clermont index. Conclusions The three MRE-based indices evaluated in the current study have high diagnostic accuracy for assessment of disease activity. The MaRIA index has the best operational characteristics for detecting not only disease activity but also for grading severity, which supports its use in clinical studies and clinical practice.

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“…The utility of endoscopy for predicting intestinal surgery has not been fully established. Allez et al [28] reported that severe endoscopic lesions (SELs) have a more aggressive clinical course with an increased rate of surgery, while Jauregui-Amezaga et al [29] reported that the presence of SELs is not predictor of surgery in patients with CD. They emphasized the Number at risk (number of underwent surgery) (0) (5) (6) (6) (6) (8) (9) (9) (9) (9) 44 31 23 A B…”

Section: Mses-cd and The Risk Of Surgery For CDmentioning

confidence: 99%

“…In addition, infliximab therapy and disease duration were significantly associated with the event of surgery. JaureguiAmezaga et al [29] reported that immunosuppressants and anti-TNF therapy reduce the risk of the event of surgery, whereas prolonged disease duration significantly increases the risk of this event. Similar to these previous results, both infliximab and duration of disease were independent factors associated with surgery-free survival in this study.…”

Section: Figure 2 Kaplan-meier Analysis Of Surgery-free Survival Timementioning

confidence: 99%

Clinical utility of a new endoscopic scoring system for Crohn’s disease

Morise¹,

Ando²,

Watanabe³

et al. 2015

WJG

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AIM:To evaluate the clinical value of the newly modified Simple Endoscopic Score for Crohn's disease (mSES-CD). METHODS:Seventy-six Crohn's disease (CD) patients who underwent transanal double balloon endoscopy (DBE) in our hospital between 2003 and 2012 were retrospectively reviewed. DBE is defined as small intestinal endoscopy using two attached balloons. We included patients with stenosis which hampered passage of the scope and those who underwent DBE with observation for at least 80 cm from the ileocecal valve. Our new mSES-CD assesses the endoscopic activity of two consecutive small intestinal segments located 0-40 cm and 40-80 cm from the ileocecal valve by DBE, in addition to the activity of four colorectal segments. To compare the usefulness of mSES-CD with SES-CD, we similarly divided the patients into two groups according to total mSES-CD score (low disease activity group, < 4; high disease activity group, ≥ 4). The clinical value of mSES-CD in predicting clinical outcome in patients with CD was evaluated using the occurrence of surgery after DBE as an endpoint. RESULTS:Median age of the 76 CD patients was 36 years (range, 16-71). Thirty-nine patients had stenosis which hampered passage of the DBE to 80 cm on the proximal side from the ileocecal valve. Median evaluable length of small intestine by DBE was 80 cm (range, 3-200). A total of 74 patients had one or more small intestinal lesions detected by DBE, of which 62 (83.8%) were within 80 cm of the ileocecal valve on the proximal side. Only two patients (2.7%) with proximal- [6,7] . The SES-CD scores four variables -ulcer size, extent of ulcerated surface, extent of affected surface, and stenosis -from 0 to 3 in the five segments of the ileum, right colon, transverse colon, left colon, and rectum. Daperno et al [8] reported that the SES-CD is a simple, reproducible, and easily used endoscopic scoring system for CD, and showed a strong correlation with CDEIS (r = 0.920). The recent availability of double balloon endoscopy (DBE) allows evaluation of the activity of small intestinal lesions as well as colorectal lesions by an endoscopic procedure. Although a number of incidents have been reported, serious complications with DBE are rare, particularly with diagnostic DBE [9][10][11] . To date, however, a method of evaluating MH in CD which includes the small intestine has not been established. To date, capsule endoscopy (CE) and magnetic resonance enterography (MRE) have both been shown to be capable of assessing mucosal healing [12][13][14][15][16] . ORIGINAL ARTICLEHowever, a method of evaluating MH which includes small intestinal lesions in patients with CD using DBE has not been established. Here, we assessed the importance of evaluating the endoscopic activity of small intestinal lesions by DBE. We also propose a newly modified Simple Endoscopic Score for Crohn's disease (mSES-CD), which includes assessment of the endoscopic activity of small intestinal lesions, and evaluate its usefulness in predicting the prognosis of CD. MATERIALS AND ...

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Value of endoscopy and MRI for predicting intestinal surgery in patients with Crohn's disease in the era of biologics

Cited by 76 publications

References 19 publications

Evolving roles of cross-sectional imaging in Crohn's disease

Evolving roles of cross-sectional imaging in Crohn's disease

Comparison of three magnetic resonance enterography indices for grading activity in Crohn’s disease

Clinical utility of a new endoscopic scoring system for Crohn’s disease

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