The role of calprotectin in predicting endoscopic post-surgical recurrence in asymptomatic Crohn's disease: a comparison with ultrasound.
OBJECTIVE
Faecal calprotectin is predictive of clinical relapse in inflammatory bowel disease and ultrasound is sensitive in detecting its post-surgical recurrence. However, no data regarding the role of calprotectin in predicting post-surgical recurrence in asymptomatic Crohn's disease are available. The aim of this study was to prospectively evaluate the role of calprotectin as a predictive marker for one year post-surgical endoscopic recurrence in comparison with ultrasound in patients with asymptomatic Crohn's disease.


METHODS
We consecutively enlisted 50 patients who had undergone a resection for Crohn's disease. Faecal calprotectin was analysed and ultrasound were performed at the third month, and a colonoscopy after one year. The sensitivity and specificity of these two techniques were evaluated using endoscopic findings as a golden standard. A Receiver Operator Curve (ROC) curve was plotted, in order to identify the best-cut off value for calprotectin.


RESULTS
39 out of 50 patients were evaluated by performing a colonoscopy after one year; 19 patients had an endoscopic recurrence after one year. Calprotectin sensitivity and specificity were calculated for 5 different cut-off values; the best cut-off value for calprotectin sensitivity (63%) and specificity (75%) was > 200 mg/L. The US sensitivity and specificity at the third month were 26% and 90% respectively.


CONCLUSIONS
When performed three months after surgery ultrasound is more specific than calprotectin in predicting endoscopic recurrence. Faecal calprotectin at a dosage > 200 mg/L seems to have a better sensitivity than ultrasound. Values of calprotectin > 200 mg can be an indication to colonoscopy in the group of patients with negative ultrasound in order to detect early recurrence.
Orlando
A
A
Department of Internal Medicine, V Cervello Hospital, Palermo, Italy.
Modesto
I
I
Castiglione
F
F
Scala
L
L
Scimeca
D
D
Rispo
A
A
Teresi
S
S
Mocciaro
F
F
Criscuoli
V
V
Marrone
C
C
Platania
P
P
De Falco
T
T
Maisano
S
S
Nicoli
N
N
Cottone
M
M
D000293:Adolescent; D000328:Adult; D015415:Biomarkers / Q000032:analysis; D003113:Colonoscopy; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000378:metabolism*; D005243:Feces / Q000737:chemistry*; D005260:Female; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging* / Q000473:pathology; D039841:Leukocyte L1 Antigen Complex / Q000032:analysis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012008:Recurrence; D012680:Sensitivity and Specificity; D014463:Ultrasonography
D015415:Biomarkers; D039841:Leukocyte L1 Antigen Complex