Prognostic Value of Enterography Findings in Crohn's Disease: A Systematic Review and Meta-Analysis

Crohn's disease is a chronic inflammatory disorder with variable progression that often leads to hospitalization, treatment escalation, or surgery. While clinical and endoscopic indices guide disease monitoring, cross-sectional enterography provides unique visualization of transmural and extramural inflammation, offering valuable prognostic information. This systematic review and meta-analysis examined the prognostic significance of magnetic resonance enterography (MRE) and computed tomography enterography (CTE) in Crohn's disease. Following PRISMA guidelines and a registered protocol, eight databases were systematically searched through August 2024. Two reviewers independently conducted data extraction, risk-of-bias assessment (QUADAS-2), and certainty grading (GRADE). Random-effects models were applied for pooled analyses. Eleven studies, including more than 1500 patients, met eligibility criteria. Across cohorts, transmural healing on enterography was consistently associated with favorable long-term outcomes, including a markedly lower need for surgery and hospitalization. Conversely, stenosis and persistent inflammatory activity identified patients at substantially higher risk of surgery, treatment intensification, or disease-related hospitalization. The certainty of evidence was high for surgical outcomes and moderate to low for other endpoints. Conventional enterography provides meaningful prognostic insight into Crohn's disease and should be considered a complementary tool for risk stratification and treatment planning. Transmural healing represents a protective marker of a favorable disease course, whereas structural and inflammatory findings indicate patients who may benefit from closer monitoring or earlier therapeutic intervention.