Behaviour of the bowel wall during the first year after surgery is a strong predictor of symptomatic recurrence of Crohn's disease: a prospective study.
BACKGROUND
Recurrences after surgery for Crohn's disease are frequent and unpredictable. To date, there is little agreement as to which factors increase a patient risk of early recurrence.


OBJECTIVE
To assess whether the post-operative behaviour of diseased bowel walls, as determined by ultrasound, may be a useful predictor of relapse.


METHODS
A total of 127 Crohn's disease patients were monitored after surgery by means of bowel ultrasound as well as by clinical and laboratory evaluations for a median follow-up of 41.0 months. Bowel wall thickness of diseased loops measured at ultrasound during follow-up was compared with the presurgery values. Multivariable survival analysis was performed to elucidate predictors of early post-operative recurrence. Receiver operating characteristic curves were also constructed taking into account bowel wall thickness for selecting Crohn's disease patients with high risk of clinical/surgical recurrence.


RESULTS
The estimated 5 years survival probability of symptomatic Crohn's disease recurrence were 90% and 33%, respectively for unchanged/worsened bowel wall thickness vs. improved bowel wall thickness at 12 months from surgery. The hazard ratio for unchanged/worsened bowel wall thickness at 12 months was 8.9 (95% CI: 3.4-23.2). Receiver operating characteristic curve identified a bowel wall thickness > 6.0 mm at 12 months from surgery as directly associated with the risk of having a Crohn's disease recurrence (hazard ratio was 6.5, 95% CI: 2.8-15.4).


CONCLUSIONS
Systematic ultrasound follow-up of diseased bowel walls after conservative surgery allows the early identification of patients at high risk of clinical/surgical recurrence.
Parente
F
F
Academic Department of Gastroenterology, L.Sacco University Hospital, Milan, Italy. fabrizio.parente@tiscalinet.it
Sampietro
G M
GM
Molteni
M
M
Greco
S
S
Anderloni
A
A
Sposito
C
C
Danelli
P G
PG
Taschieri
A M
AM
Gallus
S
S
Bianchi Porro
G
G
D000293:Adolescent; D000328:Adult; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D003424:Crohn Disease / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D011446:Prospective Studies; D012372:ROC Curve; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography