Ultrasonographic Detection of Early Post-Surgical Recurrence in Crohn's Disease

Abstract

PurposeAt present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard.Material & MethodsWe recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids).ResultsB-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR.ConclusionB-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy. PurposeAt present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard. At present, gold standard for pre-clinical assessment of post-surgical recurrence (PSR) in Crohn's disease (CD) is colonoscopy. Endoscopy examination is invasive, so there is a need for noninvasive and accurate methods for the diagnosis of PSR. The aim of this study was to evaluate the diagnostic performance of bowel ultrasound (B-US) in assessing early PSR when using colonoscopy as gold standard. Material & MethodsWe recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids). We recruited 107 consecutive CD patients with ileocolonic resection. Recurrence was assessed by colonoscopy using the Rutgeerts' score. B-US was executed 3-6-12 months after surgery. B-US parameters considered were bowel wall thickness (BWT) measured at the level of the anastomosis, echopattern, mesenteric hypertrophy, Power Doppler signal, enlarged mesenteric lymphnodes, and complications (stricture, fistulae, abscesses, abdominal free fluids). ResultsB-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR. B-US and colonoscopy detected findings compatible with PSR in 93 (86.9%) and 92 (86.0%) patients, respectively. On the ROC curve a BWT > 2.5 mm showed sensitivity, specificity, and LR + of 95.6%, 66.6% and 2.87 (AUC 0.834) in predicting endoscopic PSR. At multiple logistic regression analyses BWT of anastomosis (> 2.5 mm) was the only B-US characteristic significantly (P < 0.0001) and independently (OR = 0.0227, 95% CI 0.0052-0.0987) associated with endoscopic degree of PSR. ConclusionB-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy. B-US shows good sensitivity and specificity for the diagnosis of PSR in CD. This noninvasive technique could replace endoscopy for the diagnosis of early PSR, especially in patients who comply poorly with the endoscopy.