Crohn’s disease is a chronic inflammatory bowel disorder characterized by an unpredictable clinical course. For many years, the therapeutic target was limited to achieving clinical remission associated with normalization of inflammatory biomarkers. To improve long-term outcomes, the STRIDE II recommendations introduced endoscopic healing as a therapeutic target, defined by an SES-CD < 3 (Simple Endoscopic Score for Crohn's Disease) or a CDEIS < 3 (Crohn's Disease Endoscopic Index of Severity).

    Today, the concept of complete endoscopic healing is emerging as a potentially more relevant therapeutic goal.

     The aim of the present study is to determine whether complete endoscopic healing is associated with improved long-term outcomes.

    This observational, cross-sectional, retrospective, monocentric study was conducted in our department between 2021 and 2025. We included patients with Crohn’s disease who demonstrated endoscopic healing with a CDEIS ≤ 3 on their most recent assessment colonoscopy. Patients with a CDEIS ≥ 4, those lost to follow-up, or those without an evaluation colonoscopy were excluded.

    Complete endoscopic healing was defined as a CDEIS score of 0, and partial endoscopic healing as a CDEIS score of 1–3. Relapse was defined as the occurrence of a clinical flare.

    Statistical analysis was performed using the Jamovi software, and associations between variables were assessed using the χ² test.

      A total of 60 patients in endoscopic remission were included, equally divided into 30 with complete healing and 30 with partial healing. The mean age was 45.7 ± 13.5 years (range: 18–78), with a marked female predominance (female-to-male ratio: 2.75).

    According to the Montreal classification, phenotype distribution was as follows: 34 patients in A2 (56.7%), 21 in A3 (35%), and 5 in A1 (8.3%). Disease location was predominantly L3 (43 patients, 71.7%), followed by L2 (13 patients, 21.7%) and L1 (4 patients, 6.7%). The B2 phenotype was most frequent (25 patients, 41.7%), followed by B1 (20 patients, 33.3%). Perianal disease was present in 27 patients (45%).

    Regarding treatment, 41 patients were initially treated with immunosuppressants (68.3%), while 19 received biologics (31.7%), including 18 on infliximab (30%) and 1 on adalimumab (1.7%).

       The mean follow-up duration was 30.2 ± 10.4 months. Disease evolution was marked by relapse in 2 patients with CDEIS = 0 (6.7%) versus 16 patients with CDEIS 1–3 (53.3%) (p < 0.001).Therapeutic adjustment was required in 16 patients with CDEIS = 0 (53.3%) and in 25 patients with CDEIS 1–3 (83.3%) (p = 0.012).

      A reassessment colonoscopy was performed in 13 patients (21.7%): 6 with complete healing and 7 with partial healing. All patients with initial complete healing maintained a CDEIS = 0, whereas among those with partial healing, 4 patients (57.1%) had a follow-up CDEIS of 4, 2 patients (28.6%) had a score of 3, and 1 patient (14.3%) had a score of 1 (p = 0.005).

     Therapeutic strategy differed significantly between the two groups. De-escalation therapy was undertaken in 13 patients with initial complete healing (81.3%), whereas a step-up approach was applied in 15 patients with partial healing (60%) and treatment optimization in 4 patients (16%) (p < 0.001).

   Hospitalization was required for none of the patients with complete healing (0%), compared with 8 patients with partial healing (26.7%) (p = 0.002).

     Similarly, no surgical intervention was required for patients with complete healing (0%), while 6 patients (20%) with partial healing underwent surgery (p = 0.010).

    Complete endoscopic healing was associated with more favorable outcomes compared with partial healing. It correlated with a significantly reduced risk of relapse, hospitalization, and surgical complications, while also allowing for therapeutic de-escalation. These findings highlight the relevance of adopting a stricter definition of endoscopic healing, paving the way for a re-evaluation of current therapeutic targets.