SNFGE SNFGE
 
Thématique :
- MICI
Originalité :
Très original
Solidité :
Très solide
Doit faire évoluer notre pratique :
Immédiatement
 
 
Nom du veilleur :
Professeur Vered ABITBOL-SELINGER
Coup de coeur :
 
 
The American Journal of Gastroenterology
  2018/02  
 
  2018 Feb;113(2):283-294.  
  doi: 10.1038/ajg.2017.464.  
 
  Utility of Magnetic Resonance Enterography For Small Bowel Endoscopic Healing in Patients With Crohn’s Disease  
 
  Takenaka K, Ohtsuka K, Kitazume Y, Matsuoka K, Nagahori M, Fujii T, Saito E, Kimura M, Fujioka T, Watanabe M  
  https://www.ncbi.nlm.nih.gov/pubmed/29257147  
 
 

Abstract

OBJECTIVES:

Small bowel (SB) endoscopic healing has not been well studied in patients with Crohn's disease (CD). This study aims to evaluate the utility of magnetic resonance (MR) enterography (MRE) for SB lesions in comparison with balloon-assisted enteroscopy (BAE) findings.

METHODS:

In total, 139 patients with CD in clinical-serological remission were prospectively followed after BAE and MRE procedures. We applied a modified version of the Simple Endoscopic Score for CD (SES-CD) for an endoscopic evaluation of the SB, called the Simple Endoscopic Active Score for CD (SES-CDa). We also used the MR index of activity (MaRIA) for MR evaluations. The primary end points were time to clinical relapse (CD activity index of >150 with an increase of >70 points) and serological relapse (abnormal elevation of C-reactive protein).

RESULTS:

Clinical and serological relapses occurred in 30 (21.6%) and 62 (44.6%) patients, respectively. SB endoscopic healing (SES-CDa<5) was observed in 76 (54.7%) patients. A multiple regression analysis showed that the lack of SB endoscopic healing was an independent risk factor for clinical relapses (hazard ratio (HR): 5.34; 95% confidence interval (CI): 2.06-13.81) and serological relapses (HR: 3.02; 95% CI: 1.65-5.51), respectively. MR ulcer healing (MaRIA score <11) demonstrated a high diagnostic accuracy (90.9%; 95% CI: 87.9-93.2%) for endoscopic healing. The kappa coefficient between BAE and MRE for longitudinal responsiveness was 0.754 (95% CI: 0.658-0.850) for clinical relapse and 0.783 (95% CI: 0.701-0.865) for serological relapse.

CONCLUSIONS:

SB inflammation was associated with a poor prognosis in patients with clinical-serological remission. MRE is a valid and reliable examination for SB inflammatory activity both for cross-sectional evaluations and prognostic prediction.

 

 
Question posée
 
Evaluer l’utilité de l’entéro-IRM dans l’évaluation de la cicatrisation muqueuse de la maladie de Crohn du grêle par comparaison avec l’entéroscopie assistée par ballon.
 
Question posée
 
L’entero-IRM est un examen fiable dans l’évaluation de l’inflammation muqueuse dans la maladie de Crohn du grêle permettant de prédire une rechute clinique.
 
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