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Crohn's disease (CD) is a chronic and progressive condition leading to cumulative bowel damage overtime, mainly related to stricturing or penetrating lesions. About half of patients with CD require surgical intestinal resection 10 years after diagnosis.1 Importantly, the development of disease complications (stricture, fistula and/or abscess) is known to be the main indication for surgery in these patients.1 The identification of factors associated with a higher need for surgery for CD is a prerequisite to the development of therapeutic strategies potentially altering disease course, with the final aim of preventing undertreatment and avoiding overtreatment with biologics.
Clinical risk factors are insufficient to predict disease course,2 and there is a well-known disconnect between clinical symptoms and endoscopic disease activity.3 Hence, we need to look beyond clinical symptoms. Accumulating evidence indicates that mucosal healing may change the natural course of the disease by decreasing the need for surgery and reducing hospitalisation rates in CD.4 However, no controlled trials addressed this question and only indirect evidence is available. Furthermore, CD is a transmural disease, and endoscopy, which is still the gold standard for assessing disease activity in CD, cannot detect the presence of bowel damage. Over the last decade, cross-sectional imaging techniques, such as MRI, CT and ultrasound, have …