Usefulness of magnetic resonance enterography in the clinical decision-making process for patients with inflammatory bowel disease

• Published in: Gastroenterología y Hepatología (English Edition) 2020-10, Vol.43 (8), p.439-445
• Main Authors: Ramos López, Laura, Hernández Camba, Alejandro, Rodríguez-Lago, Iago, Carrillo Palau, Marta, Cejas Dorta, Luis, Elorza, Ainara, Alonso Abreu, Inmaculada, Vela, Milagros, Hidalgo, Alba, Hernández Álvarez-Builla, Noemi, Rodríguez, G. Esther, Rodríguez, Yolanda, Tardillo, Carlos, Díaz-Flórez, Lucio, Eiroa, Daniel, Aduna, Marta, Garrido, María S., Larena, José A., Cabriada, José L., Quintero Carrion, Enrique
• Format: Article
• Language: English
• Subjects: Clinical decision-making; Enfermedad inflamatoria intestinal; Enterografía por resonancia magnética; Inflammatory bowel disease; Magnetic resonance enterography; Toma de decisiones clínicas
• ISSN: 2444-3824; 2444-3824
• DOI: 10.1016/j.gastre.2020.03.001

To evaluate the impact of magnetic resonance enterography (MRE) diagnosis on clinical decision-making regarding treatment choice and maintenance of treatment over time in patients with inflammatory bowel disease (IBD). A cohort of patients who underwent MRE for IBD assessment between 2011 and 2014 was analyzed. From clinical records, we retrospectively retrieved their demographic data and clinical data on their IBD at the time of MRE, the results of MRE and the patient's clinical course. Medical management decisions made during the three months following MRE and at the 15-month follow-up were assessed. In total, 474 MREs were reviewed. In the first three-month period, MRE results led to changes in the medical management of 266 patients (56.1%). Of those, maintenance therapy was altered in 140 patients (68.3%) (90.7% step-up and 9.3% top-down strategy), 65 (24.4%) were prescribed a course of steroids and 61 (22.9%) underwent surgery. MRE confirmed a CD diagnosis in 14/41 patients (34.1%) previously diagnosed with indeterminate colitis or ulcerative colitis and in 4/18 patients (22.2%) with suspected IBD. At the 15-month follow-up, treatment remained unchanged in 289 patients (65.8%). These results suggest that MRE is a diagnostic tool that provides valid information for the clinical-decision making process for patients with CD. Evaluar el impacto del diagnóstico de la enterografía por resonancia magnética (ERM) en la toma de decisiones clínicas con respecto a la elección del tratamiento y el mantenimiento del mismo a lo largo del tiempo en pacientes con enfermedad inflamatoria intestinal (EII). Se analizó una cohorte de pacientes que se sometieron a ERM para la evaluación de EII entre 2011 y 2014. De los registros clínicos recuperamos retrospectivamente sus datos demográficos y datos clínicos sobre su EII en el momento de la ERM, los resultados de la ERM y la evolución clínica del paciente. Se evaluaron las decisiones de manejo médico tomadas durante los 3 meses posteriores a la ERM y a los 15 meses de seguimiento. Se revisaron 474 ERM. En el primer período de 3 meses, los resultados de la ERM llevaron a cambios en el manejo médico en 266 pacientes (56,1%). De ellos, se modificó el tratamiento de mantenimiento en 140 (68,3%) pacientes (se escaló en el 90,7% y top-down en el 9,3%), 65 (24,4%) recibieron un curso de esteroides y 61 (22,9%) se sometieron a cirugía. La ERM confirmó un diagnóstico de enfermedad de Crohn (EC) en 14/41 pacientes (34,1%) diagnostic