Tight monitoring with colonoscopy and magnetic resonance enterography improves outcomes in patients with Crohn's disease.

Background And Aims: This study evaluated the impact of monitoring with colonoscopy and magnetic resonance enterography on clinical decision-making and long-term outcomes in advanced therapy-naïve Crohn's disease patients with moderate-to-severe disease.

Methods: A retrospective review was conducted on 157 biologic-naïve Crohn's disease patients with moderate-to-severe disease at the initiation of advanced therapy between 2006 and 2023. Participants were categorized into three groups according to monitoring method within two years post-treatment: (1) tight monitoring (colonoscopy and magnetic resonance enterography), (2) semi-tight monitoring (either colonoscopy or magnetic resonance enterography), and (3) conventional monitoring (clinical outcomes including laboratory tests only). Treatment adjustments and long-term outcomes were compared.

Results: Of 157 patients (69.4% male, median age 31 years), tight monitoring was associated with increased immunomodulator use (27.2% vs. 3.8%;  < 0.001) and reduced hospitalizations compared to conventional monitoring (5.4% vs. 38.8%;  < 0.001). The incidence of strictures was 0% in the tight monitoring group, compared to 21.3% in the conventional monitoring group, respectively ( = 0.011).

Conclusion: Tight monitoring with both colonoscopy and magnetic resonance enterography within 2 years after advanced therapy initiation in patients with moderate-to-severe Crohn's disease is associated with timely treatment adjustments and improved long-term outcomes, particularly through better detection of residual inflammation.