W1144 Comparison Between Techniques Providing the Luminal vs Extraluminal Surface in Assessing Crohn's Disease Recurrence: A Prospective Longitudinal Study

Abstract

Background. Ileocolonoscopy (IC) represents the gold standard for assessing Crohn's Disease (CD) recurrence 1 yr after surgery. The role of IC in the longer follow up, as also the possible clinical usefulness of procedures providing different views (i.e. extravs intraluminal) of the peri-anastomotic area is undefined. Aim. In a prospective longitudinal study in CD pts. undergoing ileo-colonic resection, we aimed to assess the possible correlation between clinical outcome and severity of recurrence as assessed by procedures visualizing either the luminal (IC and small bowel follow through, SBFT) or the extraluminal surface (Small Intestine Contrast Ultrasonography; SICUS). Methods. 25 CD pts (14 M, median age 35 yrs, range 16-69) undergoing resection were prospectively followed up from July 2003 to Nov. 2007, with CDAI assessment every 6 mths for 3 yrs. SICUS was performed after 375 ml PEG ingestion. SBFT and IC were performed in 13/25 pts £1 yr from surgery. After surgery, IC was performed at 1 (n=25) and 3 yrs (n=9), SBFT at 2 yrs (n=17), SICUS at 1, 2 and 3 yrs. Recurrence was assessed by IC (Rutgeerts et al), SBFT (score: G1-G4)(Hanauer,Gastroenterology 2004) and SICUS (wall thickness>3 mm) Results. Longitudinal study after surgery. Results are summarized in the Table 1. Longitudinal study before vs after surgery. In 13 pts, IC and SBFT were performed both before (£ 1 yr) and at 1 (IC) and 2 yrs (SBFT). In these pts, IC detected stenosis in 7/13 (54%) pts. before surgery and in none at 1 yr. In these 5/13 pts. showing clinical relapse at 2 yrs, recurrence was of grade 3 (n=2) and 4 (n= 3). Stenosis was detected by SBFT in all 13 pts before surgery (G4) and in 3/13 (23%) pts at 2 yrs (G1=5; G2=5; G3=0; G4=3). No correlation was observed between: A. SBFT score before vs 3 yrs after surgery (r=0.00; p=1); b. SBFT score before surgery (G4 n=13) and clinical relapse at 3 yrs (5/13 pts); c. IC and SBFT score at 1 and 2 yrs. Conclusions. The severity of endoscopic recurrence at 1 yr was predictive of clinical relapse, as expected, while the same finding was not observed by using SBFT. Although different information derive from IC and SICUS, recurrence assessment appear more comparable by using these 2 techniques when compared with SBFT. table 1