Accuracy of imaging for predicting operative approach in Crohn's disease

Malgras, Brice; Soyer, Philippe; Boudiaf, Mourad; Pocard, Marc; Lavergne‐Slove, Anne; Marteau, Philippe; Valleur, Patrice; Pautrat, Karine

doi:10.1002/bjs.8761

Cited by 26 publications

(15 citation statements)

References 47 publications

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“…MRE may prove useful during preoperative planning among Crohn's disease patients since it can diagnose small bowel and colonic lesions as well as extraintestinal lesions such as abscesses and fistulas [10][11][12][13] . Given that Crohn's disease follows a recurrent pattern, whereby patients will require multiple imaging examinations throughout their lives, the advantage of MRE over other imaging techniques lies in its lack of exposure to radiation [10,13] .…”

Section: Discussionmentioning

confidence: 99%

“…Given that Crohn's disease follows a recurrent pattern, whereby patients will require multiple imaging examinations throughout their lives, the advantage of MRE over other imaging techniques lies in its lack of exposure to radiation [10,13] . This is highlighted by the fact that Crohn's disease manifests mostly in young people.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies demonstrated that MRE is comparable or more accurate than other radiological investigations in identifying luminal and extraluminal lesions [9,10] . However, further evidence is necessary to establish MRE as a routine preoperative examination in Crohn's disease.…”

Section: Introductionmentioning

confidence: 99%

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Intra-Abdominal Adhesions Make the Interpretation of Magnetic Resonance Enterography in Crohn's Disease More Difficult

Aaltonen¹,

Keränen²,

Carpelan-Holmström³

et al. 2016

Dig Surg

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Aims: The present study compares preoperative magnetic resonance enterography (MRE) accuracy in diagnosing stenoses, abscesses and fistulas to intraoperative findings in Crohn's disease patients, and determines whether discordance between these methods alter surgical plans. Methods: Our study included 55 consecutive patients scheduled for elective surgery due to Crohn's disease in a single institution between January 2011 and May 2015, whose surgical findings were also compared to preoperative MREs. Data were retrospectively analyzed. Results: Among these 55 patients, we found 80 stenoses, 5 abscesses and 18 fistulas during surgery. The MRE sensitivity, specificity and accuracy, respectively, reached 100, 77.8 and 96.4% for stenoses; 80.0, 90.0 and 89.1% for abscesses; and 77.8, 83.8 and 81.8% for fistulas. The operative plan was modified for 7 patients (12.7%) due to erroneous MRE diagnoses. No patient needed conversion or an unplanned stoma placement due to an incorrect diagnosis using MRE. The MRE diagnosis did not agree with the surgical findings for 36 lesions, 16 of which resulted from adhesions that explained the incorrect MRE diagnoses. Conclusions: Hence, while MRE is a useful diagnostic tool preoperatively in Crohn's disease patients, the presence of intra-abdominal adhesions may cause erroneous diagnosis through MRE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Intra-Abdominal Adhesions Make the Interpretation of Magnetic Resonance Enterography in Crohn's Disease More Difficult

Aaltonen¹,

Keränen²,

Carpelan-Holmström³

et al. 2016

Dig Surg

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“…с использованием анти-цитокиновых препаратов, потребность в хирургиче-ском лечении при болезни Крона за последние 25 лет не уменьшилась [2]. До 50% пациентов с такой патологи-ей по крайней мере один раз в течение жизни нуждаются в операции по причине развившегося осложнения [3,4]. В то же время хирургические методы не гарантируют отсутствие обострений заболевания в будущем, и после оперативного этапа требуется обязательная противоре-цидивная терапия [5].…”

Section: вопросы современной педиатрииunclassified

Clinical Example of Efficiency of the Multidisciplinary Approach to the Management of a Patient with Crohn's Disease Complicated by Perianal Lesions

Габрусская¹,

Уланова²,

Filippov³

et al. 2016

Vopr. sovr. pediatr.

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ВВЕДЕНИЕ Болезнь Крона -заболевание, которое может пора-жать любой отдел желудочно-кишечного тракта, харак-теризуется тяжелым рецидивирующим течением с высо-ким риском инвалидизации. Примерно у 1/4 пациентов уже в момент постановки диагноза выявляют осложне-ния (свищи, стриктуры, абсцессы), требующие оператив-ного вмешательства [1].

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“…More than 50 % of patients with CD need surgery at least once in their lifetime to treat these complications. A large proportion of these interventions are due to stricturing disease [1][2][3]. Although immunosuppressive treatments have been used more frequently during the last 25 years, there is no significant decrease in the need for surgery in patients with CD [4].…”

Section: Introductionmentioning

confidence: 97%

Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

et al. 2014

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Crohn's disease (CD) is a chronic inflammatory bowel disease that can involve virtually any part of the gastrointestinal tract. CD complications are the main indications for surgery. A large proportion of these interventions are due to stricturing disease. Although immunosuppressive treatments have been used more frequently during the last 25 years, there is no significant decrease in the need for surgery in patients with CD. Unfortunately, surgery is not curative, as the disease ultimately reoccurs in a substantial subset of patients. To best identify the patients who will require a specific treatment and to plane the most appropriate therapeutic approach, it is important to precisely define the type, the size, and the location of CD stenosis. Diagnostic approaches aim to distinguish fibrotic from inflammatory strictures. Medical therapy is required for inflammatory stenosis. Mechanical treatments are required when fibrotic CD strictures are symptomatic. The choice between endoscopic balloon dilation, stricturoplasty, and laparoscopic or open surgery is based on the presence of perforating complications, the remaining length of small bowel, and the number and length of strictures. The non-hierarchical decision-making process for the treatment of fibrotic CD therefore requires multidisciplinary clinical rounds with radiologists, gastroenterologists, interventional endoscopists, and surgeons.

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Accuracy of imaging for predicting operative approach in Crohn's disease

Abstract: Preoperative imaging using CTE or MRE is highly accurate for assessing Crohn's disease lesions before operation, allowing correct prediction of the operative approach.

Cited by 26 publications

References 47 publications

Intra-Abdominal Adhesions Make the Interpretation of Magnetic Resonance Enterography in Crohn's Disease More Difficult

Intra-Abdominal Adhesions Make the Interpretation of Magnetic Resonance Enterography in Crohn's Disease More Difficult

Clinical Example of Efficiency of the Multidisciplinary Approach to the Management of a Patient with Crohn's Disease Complicated by Perianal Lesions

Multidisciplinary Management of Gastrointestinal Fibrotic Stenosis in Crohn’s Disease

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