Combined Endoscopic and Radiologic Approaches for Differentiating Inflammatory and Fibrotic Strictures in Crohn’s Disease

Background: Distinguishing between inflammatory and fibrotic strictures is crucial for guiding treatment strategies in Crohn’s disease. This study aims to identify the optimal approach for differentiating intestinal strictures in Crohn’s disease by combining endoscopic and radiologic examinations. Methods: This study enrolled patients who underwent surgery for Crohn’s disease intestinal strictures from March 2023 to December 2024. On the basis of operative histopathology, the strictures were classified into inflammatory, mixed and fibrotic types. Preoperative evaluations included computed tomography enterography (CTE), magnetic resonance enterography (MRE), and standardized endoscopic scoring. Clinical parameters, serum biomarkers, and imaging characteristics were analyzed to identify predictors of stricture subtypes. Results: A cohort of 39 patients with 40 surgical intestinal strictures (7 inflammatory, 8 mixed, and 25 fibrotic) underwent comprehensive evaluation. Stricture detection rates were 55.77% for CTE and 61.54% for MRE. Differentiation accuracy was 55.0%for endoscopy, 53.8%for CTE, and 67.7% for MRE. Endoscopic evaluation demonstrated superior diagnostic performance for inflammatory strictures ( P =0.007). The combination of endoscopy and MRE showed the highest AUC (0.770; P =0.020) in differentiating mixed strictures, and demonstrated equivalent sensitivity and no significant difference in specificity ( P =0.442) compared with endoscopy combined with the others. For fibrotic strictures, MRE exhibited the highest sensitivity (80.0%) but limited overall accuracy ( P =0.072). The combination of endoscopy with MRE improved the AUC (0.783; P =0.003) while achieving a statistically significant enhancement in specificity ( P =0.011). Albumin was significantly negatively correlated with inflammatory strictures. The moderate SES-CD scores were independently associated with fibrotic strictures in multivariate analysis. Conclusions: Integrating endoscopy with MRE significantly improves the diagnostic accuracy for distinguishing stricture subtypes in CD. These findings support the utility of combined imaging-endoscopic protocols for preoperative stratification of intestinal strictures.