Value of cross-sectional imaging in assessing active Crohn’s disease before stoma reversal

Dirrenberger, Bastien; Clerc‐Urmès, Isabelle; Germain, A; Bresler, L.; Olivera, Pablo; Martelli, Laura; Danese, Silvio; Baumann, Cédric; Laurent, V.; Peyrin–Biroulet, Laurent

doi:10.1016/j.dld.2017.03.028

“…However, there is little experience in the criteria for VEO-IBD stoma closure. [39][40] This study found that ileostomy accounted for more than 90% of all VEO-IBD children, and the reasons may be as follows: VEO-IBD is mainly CD, and CD mostly involves the ileocecal region. The treatment strategy has gradually changed from passive palliative care to active comprehensive management, and the need for surgical intervention is higher.…”

Section: Discussionmentioning

confidence: 92%

Risk factors for stoma-and-incision-related complications in children with very early-onset inflammatory bowel disease: A prospective cohort study

Xu

¹

,

Zhou

²

,

Tan

³

et al. 2023

Preprint

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Objective To describe the incidence of postoperative complications of enterostomy and explore the related risk factors in children with very early-onset inflammatory bowel disease (VEO-IBD). Methods Forty-three children with VEO-IBD who underwent enterostomy from January 2015 to December 2021 were included. Patients were divided into two groups according to whether they had complications after the enterostomy. The T-test and the Chi-square test were used to analyze the influencing factors of two groups of enterostomy complications. Factors screened out by univariate analysis were included in binary logistic regression. Results There were 23(53.5%) VEO-IBD patients who had ostomy complications, 16(37.2%) patients who had peristomal complications, and 15 (34.9%) patients who had incision complications after enterostomy. Univariate analysis showed that there were significant differences in Weight-for-Age Z Score (WAZ), Height-for-Age Z Score (HAZ), and weighted Pediatric Crohn's Disease Activity Index (wPCDAI) among groups with and without complications (P < 0.05). Further multivariate logistic regression analysis showed that wPCDAI was an independent risk factor for stoma-and-incision complications after enterostomy in children with VEO-IBD (P = 0.02, OR = 1.13, 95%CI = 1.02–1.25). Conclusion wPCDAI score should be fully considered before the enterostomy procedure in children with VEO-IBD.

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“…When the length of the ileocolic segment of CD on pathological examination was ≤20 cm, the mean (SD) length on MRE was 10 (13.5) cm. When the length on pathological examination was between 20 and 40 cm, the mean (SD) length on MRE was 14 (10) cm. When the length on pathological examination was >40 cm, the mean (SD) length on MRE was 18 (13) cm.…”

Section: Correlation Between Radiological and Pathological Measurementsmentioning

confidence: 99%

“…9 Surgical strategy and approach are correctly predicted by MRE in patients with CD. 8,10 When surgery is indicated in primary, stricturing, and localized CD of the small bowel, the European Crohn's and Colitis Organization (ECCO) surgical guidelines have stressed the importance of evaluation of the affected segment length to assess feasibility of surgery. 11 Only 1 study investigated the accuracy of imaging for measurement of the length of the ileocolic segment affected by CD.…”

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confidence: 99%

Preoperative Magnetic Resonance Enterography to Predict Pathological Specimen Length in Crohn’s Disease

Bihain

¹

,

Caron

²

,

Ayav

³

et al. 2022

Diseases of the Colon &Amp; Rectum

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BACKGROUND: The European Crohn’s and Colitis Organization guidelines have highlighted the importance of the preoperative evaluation of the affected segment length in patients with ileocolic Crohn's disease to determine the best surgical approach. OBJECTIVE: This study aimed to evaluate the accuracy of preoperative magnetic resonance enterography in assessing the length of the affected segment in patients with ileocolic Crohn’s disease. DESIGN: This observational study was conducted with a prospectively maintained database and retrospective analysis. SETTINGS: This study was conducted in a tertiary center. PATIENTS: This study included consecutive patients undergoing ileocolic resection for Crohn’s disease between August 2014 and June 2020. All patients underwent a preoperative magnetic resonance enterography. MAIN OUTCOME MEASURES: The correlation between the length measured on magnetic resonance enterography and pathological examination was evaluated. RESULTS: A total of 96 patients were included. The median time between magnetic resonance enterography and surgery was 65.5 (3–331) days. The length of the affected segment on magnetic resonance enterography was correlated with the length assessed on pathological evaluation (R = 0.48, p < 0.001). No correlation was found between the 2 measurements when imaging was performed >6 months before surgery (R = 0.14, p = 0.62). The presence of an abscess underestimated the length affected by Crohn’s disease on imaging compared to pathology, whereas the presence of a fistula was associated with magnetic resonance enterography overestimation of the length of the affected segment. LIMITATIONS: Limitations included single-center study and retrospective analysis. CONCLUSION: In Crohn’s disease, preoperative magnetic resonance enterography is a highly reliable tool for predicting the length of the affected segment compared to pathology examination in the absence of an abscess or fistula. See Video Abstract at http://links.lww.com/DCR/C26. ENTEROGRAFÍA POR RESONANCIA MAGNÉTICA PREOPERATORIA PARA PREDECIR LA LONGITUD DE MUESTRAS PATOLÓGICAS EN LA ENFERMEDAD DE CROHN ANTECEDENTES: Las guías de la Organización Europea de Crohn y Colitis han resaltado la importancia de la evaluación preoperatoria de la longitud del segmento afectado para determinar el mejor abordaje quirúrgico. OBJETIVO: Evaluamos la precisión de la enterografía por resonancia magnética preoperatoria para evaluar la longitud del segmento afectado en pacientes con enfermedad de Crohn ileocólica. DISEÑO: Realizamos un estudio observacional con una base de datos mantenida prospectivamente y un análisis retrospectivo. CONFIGURACIÓN: Este estudio se realizó en un centro terciario. PACIENTES: Se incluyeron pacientes consecutivos sometidos a resección ileocólica por enfermedad de Crohn entre Agosto de 2014 y Junio de 2020. A todos los pacientes se les realizó una enterografía por resonancia magnética preoperatoria. PRINCIPALES MEDIDAS DE RESULTADO: Se evaluó la correlación entre la longitud medida en la enterografía por resonancia magnética y el examen patológico. RESULTADOS: Se incluyeron un total de 96 pacientes. El tiempo mediano entre la enterografía por resonancia magnética y la cirugía fue de 65,5 (3–331) días. La longitud del segmento afectado en la enterografía por resonancia magnética se correlacionó con la longitud evaluada en la evaluación patológica (R = 0,48, p < 0,001). No hubo correlación entre las 2 mediciones cuando las imágenes se realizaron más de 6 meses antes de la cirugía (R = 0,14, p = 0,62). La presencia de un absceso subestimó la longitud afectada por la enfermedad de Crohn en las imágenes en comparación con la patología, mientras que la presencia de una fístula se asoció con una sobrestimación de la longitud del segmento afectado por enterografía por resonancia magnética. LIMITACIONES: Las limitaciones incluyeron un estudio de un solo centro y un análisis retrospectivo. CONCLUSIÓNES: En la enfermedad de Crohn, la enterografía por resonancia magnética preoperatoria es una herramienta altamente confiable para predecir la longitud del segmento afectado en comparación con el examen de patología, en ausencia de absceso o fístula. Consulte el Video Resumen en http://links.lww.com/DCR/C26. (Traducción—Dr. Yesenia Rojas-Khalil)

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Role of Cross-Sectional Imaging in Pediatric Inflammatory Bowel Disease

Grandmougin

¹

,

D’Amico

²

,

Rémen

³

et al. 2021

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Value of cross-sectional imaging in assessing active Crohn’s disease before stoma reversal

Abstract: Cross-sectional imaging revealed postoperative recurrence in about a quarter of patients before stoma reversal; this finding may influence the postoperative treatment strategy and outcomes.

Cited by 4 publications

References 50 publications

Risk factors for stoma-and-incision-related complications in children with very early-onset inflammatory bowel disease: A prospective cohort study

Risk factors for stoma-and-incision-related complications in children with very early-onset inflammatory bowel disease: A prospective cohort study

Preoperative Magnetic Resonance Enterography to Predict Pathological Specimen Length in Crohn’s Disease

Role of Cross-Sectional Imaging in Pediatric Inflammatory Bowel Disease

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