Impact of timing on mucosal healing during restaging endoscopy in pediatric Crohn's disease: A retrospective cohort
Anna Janecek1, Alexandra S Hudson1, David L Suskind1
1Division of Pediatric Gastroenterology Seattle Children's Hospital, Inflammatory Bowel Disease Center University of Washington Seattle Washington USA.
Insights
Restaging endoscopy in pediatric Crohn's disease (CD) is crucial. One in four children in clinical remission still show active inflammation, suggesting earlier endoscopic assessment may aid treatment decisions.
Area of Science:
- Pediatric Gastroenterology
- Inflammatory Bowel Disease Research
- Clinical Endoscopy
Background:
- Endoscopic remission is a key goal in pediatric Crohn's disease (CD) management.
- Optimal timing for restaging endoscopy in pediatric CD patients achieving remission is not well-established.
Purpose of the Study:
- To evaluate the timing and impact of restaging endoscopy in children newly diagnosed with CD and in remission.
- To compare outcomes between earlier (≤9 months) and later restaging endoscopy.
Main Methods:
- Retrospective cohort study of 25 pediatric CD patients.
- Analysis of endoscopic remission rates and therapy escalation based on endoscopy timing (≤9 months vs. >9 months).
Main Results:
- 72% of patients achieved endoscopic remission.
- No significant difference in endoscopic remission rates between earlier (77%) and later (67%) endoscopy groups.
- No significant difference in therapy escalation rates between the two timing groups.
Conclusions:
- A substantial proportion of pediatric CD patients in clinical and biochemical remission are not in endoscopic remission.
- The timing of restaging endoscopy did not impact remission rates or subsequent therapy escalation in this cohort.
- Earlier restaging endoscopy may offer potential benefits for clinical decision-making in pediatric CD.
Abstract:
While endoscopic remission is an important target in pediatric Crohn's disease (CD), no consensus for restaging timing exists. This retrospective cohort study assessed the timing and impact of restaging endoscopy in children with new CD in remission, comparing earlier ( ≤ 9 months) versus later endoscopy. Twenty-five patients were included (median: 12.6 years, range: 5-17). Endoscopic remission (no ulcerations) was achieved in 72% (n = 18/25). Thirteen patients (52%) had earlier endoscopy (median: 7 months, interquartile range [IQR]: 6-9, range: 3-9) while 12 (48%) had later (median: 14.5 months, IQR: 13-17, range: 11-20). There were no differences in endoscopic remission (earlier 77% vs. later 67%; p = 0.69) or therapy escalation after restaging (earlier 23% vs. later 42%; p = 0.44). This study demonstrates that one in four pediatric Crohn's disease patients in clinical and biochemical remission were not in endoscopic remission, regardless of the timing of restaging endoscopy. This indicates potential benefit to earlier restaging endoscopy in clinical decision-making.
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