Abstract
Crohn’s disease (CD) is frequently complicated by intestinal strictures, which substantially affect patients quality of life and long-term outcomes. Accurate classification of strictures—as inflammatory, fibrotic, or mixed—is critical for selecting optimal therapeutic strategies. In clinical practice, multidisciplinary team (MDT) consultation is often employed to assess stricture characteristics. However, the accuracy and inter-specialty consistency of stricture evaluation within MDTs remain inadequately characterized. This study aimed to assess the intra-disciplinary consistency and accuracy of decision-making for CD-related strictures, evaluate the accuracy of post MDT decisions, and propose recommendations for stricture nature assessment and MDT workflow optimization. A mixed-methods study was conducted at Peking Union Medical College Hospital involving 42 patients with CD and intestinal strictures. MDT participants—including specialists from gastroenterology, surgery, ultrasound, and MDT meeting chairs—were involved in evaluating intra-disciplinary decision consistency and accuracy. Semi-structured qualitative interviews were also conducted to explore factors influencing clinical decision-making. Gastroenterologists demonstrated the highest intra-team consistency (PABAK = 0.75) and diagnostic accuracy (89.3%). Ultrasound specialists showed improved consistency following targeted training (from 0.46 to 0.93). The overall accuracy of historical MDT decisions was 92.9%. Key factors influencing stricture nature judgment included clinical presentation, laboratory findings, imaging features, and endoscopic evaluation. Seven core components were identified to improve MDT workflow: expert selection, team building, training, pre-meeting preparation, in-meeting procedures, post-meeting actions, and continuous quality improvement. This study reveals variability in decision-making for CD-related strictures across different specialties. To improve diagnostic accuracy and treatment planning, we propose clear stricture classification criteria and a structured MDT workflow to standardize and enhance multidisciplinary management of CD.
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References
Dolinger, M., Torres, J. & Vermeire, S. Crohn’s disease. Lancet Lond. Engl. 403 (10432), 117791 (2024).
Yang, H. et al. Trend and geographic variation in incidence and prevalence of inflammatory bowel disease in regions across China: A nationwide employee study between 2013 and 2016. Front Med 9, 900251 (2022).
Louis, E. et al. Behaviour of Crohn’s disease according to the Vienna classification: Changing pattern over the course of the disease. Gut 49(6), 777–82 (2001).
Bai, X. et al. Long-term Disease Behavior and Surgical Intervention Analysis in Hospitalized Patients With Crohn’s Disease in China: A Retrospective Cohort Study. Inflamm. Bowel Dis. 28 (Suppl 2), S35–41 (2022).
Lu, C. et al. Systematic review: Medical therapy for fibrostenosing Crohn’s disease. Aliment Pharmacol Ther 51(12), 1233–46 (2020).
Cosnes, J., Gower-Rousseau, C., Seksik, P. & Cortot, A. Epidemiology and natural history of inflammatory bowel diseases. Gastroenterology 140 (6), 1785–1794 (2011).
Coelho, R., Ribeiro, H. & Maconi, G. Bowel thickening in Crohn’s disease: Fibrosis or inflammation? Diagnostic ultrasound imaging tools. Inflamm Bowel Dis 23(1), 23–34 (2017).
He, X. et al. Effectiveness comparison between ustekinumab and infliximab for Crohn’s disease complicated with intestinal stenosis: A multicenter real-world study. Therap Adv Gastroenterol 17, 17562848241290663 (2024).
Quaia, E., Sozzi, M., Angileri, R., Gennari, A. G. & Cova, M. A. Time-intensity curves obtained after microbubble injection can be used to differentiate responders from nonresponders among patients with clinically active Crohn disease after 6 weeks of pharmacologic treatment. Radiology 281(2), 606–616 (2016).
Ripollés, T. et al. Effectiveness of contrast-enhanced ultrasound for characterisation of intestinal inflammation in Crohn’s disease: A comparison with surgical histopathology analysis. J. Crohns Colitis 7(2), 120–8 (2013).
Chiorean, M. V. et al. Correlation of CT enteroclysis with surgical pathology in Crohn’s disease. Am. J. Gastroenterol. 102(11), 2541–50 (2007).
Kobeissy, A. et al. Evaluating the diagnostic accuracy of magnetic resonance imaging in distinguishing strictures in Crohn’s disease: A systematic review and meta-analysis. Int. J. Colorectal Dis. 38(1), 258 (2023).
Rieder, F. et al. Reliability of CT enterography for describing fibrostenosing Crohn disease. Radiology 312(2), e233038 (2024).
De Kock, I. et al. MRI texture analysis of T2-weighted images is preferred over magnetization transfer imaging for readily longitudinal quantification of gut fibrosis. Eur. Radiol. 33(9), 5943–52 (2023).
Bettenworth, D. et al. Assessment of Crohn’s disease-associated small bowel strictures and fibrosis on cross-sectional imaging: A systematic review. Gut 68(6), 1115–26 (2019).
Chen, Y.-J. et al. Real-time shear wave ultrasound elastography differentiates fibrotic from inflammatory strictures in patients with Crohn’s disease. Inflamm. Bowel Dis. 24(10), 2183–90 (2018).
Pavlidis, A. N. et al. Implementation and consistency of Heart Team decision-making in complex coronary revascularisation. Int. J. Cardiol. 206, 37–41 (2016).
Long, J., Luckraz, H., Thekkudan, J., Maher, A. & Norell, M. Heart Team discussion in managing patients with coronary artery disease: Outcome and reproducibility. Interact. Cardiovasc. Thorac. Surg. 14(5), 594–598 (2012).
Scott, R., Hawarden, A., Russell, B. & Edmondson, R. J. Decision-making in Gynaecological Oncology Multidisciplinary Team meetings: A cross-sectional, observational study of ovarian cancer cases. Oncol. Res. Treat. 43(3), 70–77 (2020).
Ichikawa, M. et al. Implementation rate and effects of multidisciplinary team meetings on decision making about radiotherapy: An observational study at a single Japanese institution. BMC Med. Inform. Decis. Mak. 22(1), 111 (2022).
Hamilton, D. W., Heaven, B., Thomson, R. G., Wilson, J. A. & Exley, C. Multidisciplinary team decision-making in cancer and the absent patient: A qualitative study. BMJ Open 6(7), e012559 (2016).
Wu, Q. et al. Role of a Multidisciplinary Team (MDT) in the diagnosis, treatment, and outcomes of inflammatory bowel disease: A single Chinese center’s experience. Biosci. Trends 15(3), 171–9 (2021).
Inflammatory Bowel Disease Group, Chinese Society of Gastroenterology, Chinese Medical Association, Inflammatory Bowel Disease Quality Control Center of China. 2023 Chinese national clinical practice guideline on diagnosis and management of Crohn’s Disease. Chin Med J (Engl) 137(14), 1647–50 (2024).
Gomollón, F. et al. 3rd European Evidence-based Consensus on the Diagnosis and Management of Crohn’s Disease 2016: Part 1: Diagnosis and Medical Management. J. Crohns Colitis. 11 (1), 3–25 (2017).
Rieder, F. et al. An expert consensus to standardise definitions, diagnosis and treatment targets for anti-fibrotic stricture therapies in Crohn’s disease. Aliment. Pharmacol. Ther. 48, 347–57 (2018).
Gosling, S. D., Rentfrow, P. J. & Swann, W. B. Jr. A very brief measure of the Big Five personality domains. J. Res. Pers. 37(6), 504–528 (2003).
Ma, H. et al. Optimal Heart Team Protocol to Improve Revascularization Decisions in Patients with Complex Coronary Artery Disease: A Sequential Mixed Method Study. Eur. Heart J. Qual. Care Clin. Outcomes. 8 (7), 739–749 (2022).
Byrt, T., Bishop, J. & Carlin, J. B. Bias, prevalence and kappa. J. Clin. Epidemiol. 46(5), 423–429 (1993).
Zhou, R. et al. Comparison of Radiomics and Deep Learning Using Intestinal Ultrasound Images for Differentiating Inflammatory and Fibrotic Intestinal Strictures in Crohn’s Disease. J. Inflamm. Res. 18, 16399–16410 (2025).
Tie, C., Birks, Y. & Francis, M. 30 K. Grounded theory research: A design framework for novice researchers. SAGE Open Med ;7:2050312118822927. (2019).
Li, X. X. et al. Diarrhea, large retroperitoneal mass, and chronic disseminated intravascular coagulation. Xiehe Med. J. 9 (2), 183–189 (2018).
Liang, Y. et al. Analysis of factors influencing chemotherapy decision changes for early-stage breast cancer under a multidisciplinary model. Chin. J. Cancer Prev. Treat. 22 (22), 1769–1773 (2015).
Lamb, B. W. et al. Quality improvement in multidisciplinary cancer teams: An investigation of teamwork and clinical decision-making and cross-validation of assessments. Ann. Surg. Oncol. 18(13), 3535–43. https://doi.org/10.1245/s10434-011-1773-5 (2011).
Russell, L. et al. How experienced ICU specialists make decisions on prophylactic platelet transfusions—A qualitative study. Transfusion 65 (7), 1231–1241 (2025).
Nguyen, Q. T. et al. Aspirations to study medicine, perceptions of a good doctor, and their influence on specialty choice among medical students. PLoS One. 20 (6), e0326266 (2025).
Morse, J. M. et al. Users’ guides to the medical literature. XXIII: qualitative research in health care. Are results study valid? JAMA. 284 (3), 357–362 (2000).
Mays, N. & Pope, C. Qualitative research in health care: Assessing quality in qualitative research. BMJ 320(7226), 50–52 (2000).
Acknowledgements
We sincerely thank Professor Zhe Zheng and Dr. Shen Lin’s team from Fuwai Hospital, Chinese Academy of Medical Sciences, for their valuable guidance and insightful suggestions on the study design and methodological developmen.
Funding
This work was supported by The National High-Level Hospital Clinical Research Funding (2022-PUMCH-C-018), National Natural Science Foundation of China (NSFC) (82570621), and National High-Level Hospital Clinical Research Funding – Achievement Transformation ‘Qihang Fund’ (2025-PUMCH-H-002).
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Xidong He designed the study, acquired/analyzed data, developed software, and drafted the manuscript; Xiyu Sun and Guannan Zhang acquired/analyzed data and revised the manuscript; Wenbo Li, Xiaoyin Bai and Gechong Ruan acquired/analyzed data; Yinghao Sun, Hui Xu, Hong Lv, Huijun Shu, Yue Li, and Bei Tan contributed to data acquisition and analysis; Ji Li, Jing Qin, and Li Wang revised the manuscript; Qingli Zhu, Lin Cong, Hong Yang, and Jiaming Qian supervised the study and revised the manuscript.
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This study was approved by the Ethics Committee of Peking Union Medical College Hospital, Chinese Academy of Medical Sciences (1-24PJ0075). The requirement for patient informed consent was waived by the same Ethics Committee due to the retrospective use of anonymized data (1-24PJ0075). Physician informed consent was obtained.
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†Xidong He, Xiyu Sun and Guannan Zhang contributed equally to this study.
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He, X., Sun, X., Zhang, G. et al. A mixed methods study of multidisciplinary team assessment and therapeutic decision making for intestinal strictures in Crohn’s disease. Sci Rep (2026). https://doi.org/10.1038/s41598-026-42386-2
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DOI: https://doi.org/10.1038/s41598-026-42386-2
