Clinical value of CT enterography imaging features in predicting enteroscopy passage in Crohn's disease.

Rationale and objective: Small bowel strictures in Crohn's disease (CD) can hinder enteroscopy, thereby limiting its diagnostic utility. This study aimed to evaluate whether CT enterography (CTE) imaging features can predict enteroscopy passage in CD patients.

Methods: This retrospective cohort study included 277CD patients who underwent both CTE and enteroscopy at two institutions between March 2021 and December 2024. CTE served as the index test, with enteroscopy passage as the reference standard. Patients were divided into a training cohort (151 patients, Center 1) and a validation cohort (126 patients, Center 2). CTE features, including stricture length, bowel wall thickness, and upstream bowel dilatation, were assessed. Logistic regression analysis identified independent predictors of enteroscopy passage. Receiver operating characteristic (ROC) curve analysis determined the optimal cutoff values and predictive performance.

Results: The study included 176 men and 101 women (mean age, 40.2 ± 13.6 years; mean BMI, 21.56 ± 3.33 kg/m²). Interobserver variability for enteroscopy passage assessment showed kappa values of 0.690 and 0.807, indicating substantial to excellent consistency. Upstream bowel dilatation was the strongest predictor, with an optimal cutoff of 26.5 mm. The area under the curve (AUC) was 0.821 (95 % CI: 0.76-0.88, p < 0.05) in the training cohort and 0.808 (95 % CI: 0.74-0.88, p < 0.05) in the validation cohort.

Conclusion: CTE imaging features, particularly upstream bowel dilatation, demonstrated strong predictive value for enteroscopy passage in CD patients and may aid clinical decision-making.