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A GLOBAL CONSENSUS ON THE DEFINITIONS, DIAGNOSIS AND MANAGEMENT OF FIBROSTENOSING SMALL BOWEL CROHN'S DISEASE

Dominik Bettenworth 1,2, Mark Baker 3, Joel Flechter 4, Vipul Jairath 5, Cathy Lu 6, Wilhelmus A. Bemelman 7, Geert D’Haens 8, André D'Hoore 9, Axel Dignass 10, Iris Dotan 11, Roger Feakins 12, Phillip Fleshner 13, Christina Ha 14, Gaylyn Henderson 15, Ruishen Lyu 3, Julian Panés 16, Gerhard Rogler 17, Ren Mao 18, Jordi Rimola 16, William Sandborn 19, Siew Chien Ng 20, Britta Siegmund 21, Mark S. Silverberg 22, Stuart Taylor 23, Bram Verstockt 24, Ilyssa O. Gordon 25, David H. Bruining 26, Brian G. Feagan 27, Florian Rieder 28,25,3

Affiliations

1 CED Schwerpunktpraxis, Münster, Germany

2 University of Münster, Münster, Germany

3 Cleveland Clinic, Cleveland, United States

4 Mayo Clinic, Rochester, United States

5 Alimentiv Inc., London, Canada

6 University of Calgary, Calgary, Canada

7 Academisch Medisch Centrum, Amsterdam, Netherlands

8 Amsterdam University Medical Centers, Amsterdam, Netherlands

9 University Hospitals Leuven, Leuven, Belgium

10 Agaplesion Markus Krankenhaus, Frankfurt/ Main, Germany

11 Rabin Medical Center, Petah Tikva, Israel

12 Royal London Hospital, London, United Kingdom

13 Cedars-Sinai Medical Center, Los Angeles, United States

14 Mayo Clinic Arizona, Scottsdale, United States

15 Gutless and Glamorous, Atlanta, United States

16 Hospital Clínic Barcelona, Barcelona, Spain

17 UniversitätsSpital Zürich, Zürich, Switzerland

18 The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

19 University of California San Diego, San Diego, United States

20 The Chinese University of Hong Kong, Hong Kong, China

21 Charité - Universitätsmedizin Berlin, Berlin, Germany

22 Mount Sinai Hospital, Toronto, Canada

23 University College London - Centre for Medical Imaging, London, United Kingdom

24 University Hospitals Leuven and KU Leuven, Translational Research in Gastrointestinal Disorders - IB, Leuven, Belgium

25 Cleveland Clinic Foundation, Cleveland, United States

26 Mayo Clinic College of Medicine, Rochester, United States

27 The University of Western Ontario, London, Canada

28 Cleveland Clinic Foundation, Cleveland Heights, United States

Summary

AI Generated

A global expert panel developed consensus recommendations for the diagnosis and management of fibrostenotic Crohn's disease using a RAND/UCLA appropriateness methodology.

No accurate predictive biomarkers are currently available for naïve or anastomotic fibrostenosing strictures in Crohn's disease.
Accurate diagnosis of fibrostenosing Crohn's disease requires cross-sectional imaging to evaluate bowel wall thickness, luminal narrowing, prestenotic dilatation, and potential inflammatory component.
Abdominal cross-sectional imaging was considered necessary prior to any treatment decision.
The panel of 27 global experts and one patient representative proposed approaches to medical, endoscopic, and surgical therapies, including technical characteristics for endoscopic balloon dilation and follow-up strategies.
This consensus provides clinical guidance for diagnostic and therapeutic management in the absence of prior global consensus recommendations.

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This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

Abstract

Introduction

Small bowel fibrostenotic strictures are common in patients with Crohn’s disease (CD). No global consensus recommendations on definitions, diagnosis and clinical management are available.

Aims & Methods

Several systematic reviews followed by a RAND/University of California Los Angeles appropriateness study on the definitions, diagnosis and clinical management of fibrostenosing CD in clinical practice were performed. A panel of 27 global experts and a patient representative were convened. They assessed a total of 152 candidate items. The items were subsequently evaluated for appropriateness.

Results

No accurate predictive biomarkers are available for naïve or anastomotic fibrostenosing strictures. Accurate diagnosis of fibrostenosing CD requires cross-sectional imaging which should evaluate bowel wall thickness, luminal narrowing and prestenotic dilatation. A potential inflammatory component should be assessed. Abdominal cross-sectional imaging was considered necessary prior to any treatment decision. The panel proposed an approach to medical, endoscopic, and surgical therapies. Technical characteristics for endoscopic balloon dilation and follow up strategies after successful dilation therapy were identified. Appropriateness, types and performance of different surgical approaches in various settings were evaluated.

Conclusion

This global consensus provides clinical guidance for the diagnostic and therapeutic management of patients with fibrostenotic CD.

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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