NEW YORK (Reuters Health) – In most patients with Crohn’s disease, endoscopic findings have relatively little impact on clinical decision making, results of a study conducted in Italy suggest.

“In the majority of cases a correct therapeutic decision may be established simply on the basis of clinical picture and non-invasive markers,” the study team concludes in the September issue of Digestive and Liver Disease.

The impact of endoscopy in the management of Crohn’s disease has been evaluated in only a few studies, and few guidelines exist on the correct use of endoscopy in this patient population, Dr. Gianpiero Manes and colleagues from L. Sacco University Hospital, Milan, point out.

This led the research team to evaluate the clinical impact of colonoscopy in 204 consecutive patients with Crohn’s disease. The study was made up of 116 men and 88 women with a mean age of 41 years. According to current guidelines, colonoscopy was judged to be indicated in 52.9% of study subjects.

Overall, a clinically relevant lesion found in 54% of examinations, but this rate was significantly lower for non-indicated procedures (25.9%), the researchers report. “The likelihood of obtaining a relevant finding was 2.26 times higher when endoscopy was appropriate,” they note.

According to the investigators, an adequate degree of agreement (76.9%) was observed between what the endoscopist would have done before and after endoscopy, but in about 25% of patients, endoscopy findings did not align with clinical symptoms and thus the procedure was potentially able to modify the immediate therapeutic decision.

However, the researchers say “the impact of endoscopic findings on the endoscopist’s decision was likely to be very small without any differences between appropriate and inappropriate procedures.”

This suggests to the researchers that the management of patients with Crohn’s disease should be based mainly on the clinical evaluation. In most patients with Crohn’s disease, endoscopy adds additional useful information only in a limited number of cases, they conclude.

Still, Dr. Manes and colleagues point out, with the recent introduction of biological therapies, endoscopy is “likely to have gained new importance since (it’s) able to offer information on the degree of mucosal healing and thus (influence) the prognostic assessment of patients with Crohn’s disease.”

Reference:
Dig Liver Dis 2009;41:653-658.