Therapeutic Efficacy of Risankizumab for Small-Intestinal Lesions in Crohn’s Disease: A Retrospective Study Using Double-Balloon Endoscopy

INTRODUCTION: Risankizumab (RZB), an IL-23p19 monoclonal antibody, has demonstrated clinical efficacy in Crohn's disease (CD), yet evidence regarding its effectiveness for deep small-intestinal lesions remains scarce. These lesions are often underdiagnosed due to limited accessibility and subtle clinical presentation. METHODS: We retrospectively analyzed 32 patients with moderate-to-severe CD who underwent total small-intestinal evaluation by double-balloon endoscopy (DBE) both before and 8-14 months after RZB initiation in clinical practice. Endoscopic disease activity was assessed using the modified Simple Endoscopic Score for Crohn's Disease (mSES-CD). Clinical response (Crohn's Disease Activity Index [CDAI]), biomarker changes (C-reactive protein, leucine-rich alpha-2 glycoprotein), and endoscopic outcomes were evaluated. RESULTS: Mean mSES-CD significantly decreased from 14.3 to 8.2 (p < 0.001), indicating substantial mucosal improvement, particularly in the jejunum and deep ileum. Endoscopic remission (mSES-CD