Skip to main content

Advertisement

SpringerLink
Log in

Clinical outcome is distinct between radiological stricture and endoscopic stricture in ileal Crohn’s disease

  • Gastrointestinal
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

Differences in clinical adverse outcomes (CAO) based on different intestinal stricturing definitions in Crohn’s disease (CD) are poorly documented. This study aims to compare CAO between radiological strictures (RS) and endoscopic strictures (ES) in ileal CD and explore the significance of upstream dilatation in RS.

Methods

This retrospective double-center study included 199 patients (derivation cohort, n = 157; validation cohort, n = 42) with bowel strictures who simultaneously underwent endoscopic and radiologic examinations. RS was defined as a luminal narrowing with wall thickening relative to the normal gut on cross-sectional imaging (group 1 (G1)), which further divided into G1a (without upstream dilatation) and G1b (with upstream dilatation). ES was defined as an endoscopic non-passable stricture (group 2 (G2)). Strictures met the definitions of RS (with or without upstream dilatation) and ES were categorized as group 3 (G3). CAO referred to stricture-related surgery or penetrating disease.

Results

In the derivation cohort, G1b (93.3%) had the highest CAO occurrence rate, followed by G3 (32.6%), G1a (3.2%), and G2 (0%) (p < 0.0001); the same order was found in the validation cohort. The CAO-free survival time was significantly different among the four groups (p < 0.0001). Upstream dilatation (hazard ratio, 1.126) was a risk factor for predicting CAO in RS. Furthermore, when upstream dilatation was added to diagnose RS, 17.6% of high-risk strictures were neglected.

Conclusions

CAO differs significantly between RS and ES, and clinicians should pay more attention to strictures in G1b and G3. Upstream dilatation has an important impact on the clinical outcome of RS but may not be an essential factor for RS diagnosis.

Clinical relevance statement

This study explored the definition of intestinal stricture with the greatest significance for the clinical diagnosis and prognosis of patients with CD, and consequently provided effective auxiliary information for clinicians to formulate strategies for the treatment of CD intestinal strictures.

Key Points

• The retrospective double-center study showed that clinical adverse outcome is different between radiological strictures and endoscopic strictures in CD.

• Upstream dilatation has an important impact on the clinical outcome of radiological strictures but may not be an essential factor for diagnosis of radiological strictures.

• Radiological stricture with upstream dilatation and simultaneous radiological and endoscopic stricture were at increased risk for clinical adverse outcomes; thus, closer monitoring should be considered.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

AUC:

Area under the receiver operating characteristic curve

CAO:

Clinical adverse outcome

CD:

Crohn’s disease

CI:

Confidence interval

CTE:

Computed tomography enterography

ES:

Endoscopic stricture

HR:

Hazard ratios

IDI:

Integrated discrimination improvement

MRE:

Magnetic resonance enterography

RS:

Radiological strictures

References

  1. Ng SC, Shi HY, Hamidi N et al (2017) Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet 390:2769–2778

    Article  PubMed  Google Scholar 

  2. Hordonneau C, Buisson A, Scanzi J et al (2014) Diffusion-weighted magnetic resonance imaging in ileocolonic Crohn’s disease: validation of quantitative index of activity. Am J Gastroenterol 109:89–98

    Article  CAS  PubMed  Google Scholar 

  3. Rieder F, Bettenworth D, Ma C et al (2018) An expert consensus to standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Crohn’s disease. Aliment Pharmacol Ther 48:347–357

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Rieder F, Zimmermann EM, Remzi FH, Sandborn WJ (2013) Crohn’s disease complicated by strictures: a systematic review. Gut 62:1072–1084

    Article  CAS  PubMed  Google Scholar 

  5. Stocker D, King MJ, El Homsi M et al (2021) Luminal narrowing alone allows an accurate diagnosis of Crohn’s disease small bowel strictures at cross-sectional imaging. J Crohns Colitis 15:1009–1018

    Article  PubMed  Google Scholar 

  6. Pariente B, Mary JY, Danese S et al (2015) Development of the Lemann index to assess digestive tract damage in patients with Crohn’s disease. Gastroenterology 148(52–63):e3

    Google Scholar 

  7. Bruining DH, Zimmermann EM, Loftus EV Jr et al (2018) Consensus recommendations for evaluation, interpretation, and utilization of computed tomography and magnetic resonance enterography in patients with small bowel Crohn’s disease. Radiology 286:776–799

    Article  PubMed  Google Scholar 

  8. Hill NS, DiSantis DJ (2015) The comb sign. Abdom Imaging 40:1010

    Article  PubMed  Google Scholar 

  9. Hayashi K, Eguchi S (2019) The power-integrated discriminant improvement: an accurate measure of the incremental predictive value of additional biomarkers. Stat Med 38:2589–2604

    Article  PubMed  Google Scholar 

  10. Vickers AJ, Elkin EB (2006) Decision curve analysis: a novel method for evaluating prediction models. Med Decis Making 26:565–574

    Article  PubMed  PubMed Central  Google Scholar 

  11. Camp RLD-FM, Rimm DL (2004) X-tile a new bio-informatics tool for biomarker assessment and outcome-based cut-point optimization. Clin Cancer Res 10:7252–7259

    Article  CAS  PubMed  Google Scholar 

  12. Blanche P, Dartigues JF, Jacqmin-Gadda H (2013) Estimating and comparing time-dependent areas under receiver operating characteristic curves for censored event times with competing risks. Stat Med 32:5381–5397

    Article  PubMed  Google Scholar 

  13. Kamarudin AN, Cox T, Kolamunnage-Dona R (2017) Time-dependent ROC curve analysis in medical research: current methods and applications. BMC Med Res Methodol 17:53

    Article  PubMed  PubMed Central  Google Scholar 

  14. Heagerty PJ, Zheng Y (2005) Survival model predictive accuracy and ROC curves. Biometrics 61:92–105

    Article  PubMed  Google Scholar 

  15. Krischer JP, Liu X, Vehik K et al (2019) Predicting islet cell autoimmunity and type 1 diabetes: an 8-Year TEDDY study progress report. Diabetes Care 42:1051–1060

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Narula N, Wong ECL, Dulai PS, Marshall JK, Colombel JF, Reinisch W (2021) Outcomes of passable and non-passable strictures in clinical trials of Crohn’s disease: a post-hoc analysis. J Crohns Colitis 15:1649–1657

    Article  PubMed  Google Scholar 

  17. Li XH, Feng ST, Cao QH et al (2021) Degree of creeping fat assessed by CT enterography is associated with intestinal fibrotic stricture in patients with Crohn’s disease: a potentially novel mesenteric creeping fat index. J Crohns Colitis 15:1161–1173

    Article  PubMed  PubMed Central  Google Scholar 

  18. Maaser C, Sturm A, Vavricka SR, et al (2019) European Crohn’s and Colitis Organisation [ECCO] and the European Society of Gastrointestinal and Abdominal Radiology [ESGAR]. ECCO-ESGAR Guideline for diagnostic assessment in IBD Part 1: Initial diagnosis, monitoring of known IBD, detection of complications. J Crohns Colitis.13:144–164

Download references

Acknowledgements

The authors would like to thank Zhan-sheng Lv for his assistance with analyzing and processing the data.

Funding

This study has received funding by National Natural Science Foundation of China (82070680, 82072002, 81970483, 82170537, 82270693).

Author information

Authors and Affiliations

  1. Department of Radiology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People’s Republic of China

    Li Shi, Yang-di Wang, Xiao-di Shen, Ji-xin Meng, Si-yun Huang, Zi-ping Li, Shi-ting Feng, Shao-chun Lin, Zhen-peng Peng & Xue-hua Li

  2. Department of Radiology, The Third Affiliated Hospital of Guangzhou Medical University, 63 Duobao Road, Guangzhou, 510150, People’s Republic of China

    Li Shi & Ting Song

  3. Department of Gastroenterology, The First Affiliated Hospital, Sun Yat-Sen University, 58 Zhongshan II Road, Guangzhou, 510080, People’s Republic of China

    Ren Mao

Authors
  1. Li Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yang-di Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiao-di Shen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ren Mao
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ji-xin Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Si-yun Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ting Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Zi-ping Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Shi-ting Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Shao-chun Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Zhen-peng Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Xue-hua Li
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Shao-chun Lin, Zhen-peng Peng or Xue-hua Li.

Ethics declarations

Guarantor

The scientific guarantor of this publication is Xue-hua Li.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained (the protocol number was IIT-2021–857).

Methodology

• retrospective

• diagnostic or prognostic study

• multicenter study

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Li Shi, Yang-di Wang, and Xiao-di Shen shared the co-first authors.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PDF 134 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shi, L., Wang, Yd., Shen, Xd. et al. Clinical outcome is distinct between radiological stricture and endoscopic stricture in ileal Crohn’s disease. Eur Radiol 33, 7595–7608 (2023). https://doi.org/10.1007/s00330-023-09743-5

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-023-09743-5

Keywords

Search

Navigation