Intestinal ultrasound effective in detecting postoperative Crohn’s recurrence
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Intestinal ultrasound is an accurate, noninvasive tool in the detection of postoperative Crohn’s disease recurrence, according to research presented at the Crohn’s and Colitis Congress.
“Surgery for Crohn's disease, unfortunately, is still common with a 10-year cumulative risk of 26%. We also know that endoscopic recurrence after resection is very common and patients who go untreated can have recurrence up to 90% in one year, and this is often clinically silent,” Michael Dolinger, MD, MBA, of the Icahn School of Medicine at Mount Sinai, said. “Colonoscopy is the gold standard. ... However, studies have shown that colonoscopy has poor compliance, is not without risk and is not ideal for repeated monitoring when patients have ulcerations at the scope. Less invasive monitoring tools for postoperative recurrence would be really valuable and important for patients.”
Dolinger and colleagues performed a cross-sectional pilot study at Mount Sinai to assess the accuracy of intestinal ultrasound (IUS) to detect the postoperative recurrence of CD. They recruited 18 patients with CD (median age 29 years; 50% women) who underwent ileocolic resection (median 45 months post-resection) and IUS within 30 days of a planned colonoscopy.
Among eight patients who had endoscopic recurrence, IUS parameters that correlated with recurrence included neo-terminal ileum bowel wall thickness (4 mm vs. 2 mm), ileocolic anastomosis hyperemia (100% vs. 20%) and neo-terminal hyperemia (75% vs. 0%).
“We are able to show that a bowel wall thickness greater than 3.2 millimeters accurately detects endoscopic recurrence with great specificity, positive predictive value, negative predictive value and an area under the curve of 0.82,” Dolinger said.
Further, traditional biomarkers such as Harvey Bradshaw Index, C-reactive protein, Endoscopic Healing Index and fecal calprotectin did not associate with endoscopic recurrence.
“Intestinal ultrasound is a feasible, accurate and noninvasive tool for the detection of postoperative Crohn's disease recurrence, and it may be more accurate than our traditional noninvasive biomarkers and clinical activity scores,” Dolinger concluded. “We need to do prospective studies to really determine how we can fit intestinal ultrasound into the monitoring of Crohn's disease patients after surgery.”
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Dolinger M. Point-of-care intestinal ultrasound for the detection of postoperative Crohn’s disease recurrence. Presented at: Crohn’s and Colitis Congress; Jan. 20-22, 2022 (virtual meeting).
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