P127. Clinical impact of MR enterography in the management of patients with Crohn's disease. An analysis of the first 100 procedures performed in a specialized unit
C. Suarez Ferrer1, Y. Gonzalez Lama2, M.I. Vera Menoza3, M. Calvo4, J. De la Revilla Negro1, M. Pastrana5, C. Gonzalez5, L.E. Abreu Garcia6
1Hospital Universitario Puerta de Hierro, Gastroenterologia y Hepatologia, Madrid, Spain; 2Hospital Universitario Puerta de Hierro, Gastroenterology, Madrid, Spain; 3Hospital Universitario Puerta de Hierro, Hospital Universitario Puerta de Hierro, Madrid, Spain; 4Hospital Puerta De Hierro, Madrid, Spain; 5Hospital Universitario Puerta de Hierro, Radiology, Madrid, Spain; 6Universitario Puerta de Hierro, Gastroenterologia y Hepatologia, Madrid, Spain
Background: MR Enterography (MRE) is a novel method for the study of Crohn's Disease (CD), however its impact in clinical practice has not been evaluated.
Methods: To evaluate the impact of MRE in clinical practice in a specialized unit of a tertiary-care hospital. The clinical and radiological data of the first 100 enteroMR procedures performed in our centre with this indication were retrospectively collected.
Results: An evaluation was performed of 100 MRE studies carried out on 100 patients, of which 50% were female, with a mean age of 43 years (range 1580), and 94% diagnosed of CD according to standard criteria. Forty percent had previously been submitted to CD related intestinal resection. Regarding treatment being received by the patients at the time of undergoing MRE, 22% were receiving biological treatment and 30% conventional immunosuppression.
In 31% of patients, MRE was indicated to rule out inflamatory activity, which was confirmed in 18 (58%) cases. These findings led to initiating biological treatments in 6 (33%) cases, with immunosuppressors in 4 (22%), and the decision to select surgical treatment in 3 (17%).
In 28% of patients, MRE was indicated to rule out the presence of stenosis, which was confirmed in 22 (79%). These findings led to initiating biological treatment in 5 (23%) cases, a change of biological treatment in 2 (9%), immunosuppressors in 6 (27%), and surgical treatment in 2 (9%).
In 15%, MRE was used to initial aproach to diagnosis of CD. Positive results were found in 7, on the basis of which treatment with steroids was commenced in 5.
In 12%, the indication was to evaluate the extension of the disease in beyond the limits of conventional endoscopy, which was confirmed in 8 (67%) patients. This led to initiating biological treatment in 4 and a change of biological treatment in 1.
In 14%, MRE was indicated for proximal intestinal evaluation when this could not be reached endoscopically due to stenosis. Activity was confirmed in 11 (79%) patients. This led to initiating biological treatment in 7 and a change of biological treatment in 1.
Overall, performing an MRE was conducive to the therapeutic escalation/increase in 51% of the first 100 patients. The MRE findings resulted in the initiation of biological treatment in 20%, and a change of biological treatment in 4%.
Conclusions: MRE is a non-invasive, accessible method which, once established in routine clinical practice, could have a great impact on the therapeutic management of CD patients.