Severity of postoperative recurrence in Crohn's disease: correlation between endoscopic and sonographic findings.
BACKGROUND
Crohn's disease (CD) recurrence is currently assessed by ileocolonoscopy. Small intestine contrast ultrasonography (SICUS) visualizes the small bowel lesions in CD, although its role after curative resection is undefined. We aimed to investigate the accuracy of SICUS in assessing CD recurrence after ileocolonic resection when using ileocolonoscopy as a gold standard. The correlation between the bowel wall thickness (BWT) measured by SICUS and the endoscopic score of recurrence was also assessed.


METHODS
The analysis included 72 CD patients with ileocolonic resection requiring ileocolonoscopy, undergoing SICUS within 6 months. Recurrence was assessed by ileocolonoscopy using the Rutgeerts' score. SICUS was performed after PEG ingestion and findings compatible with recurrence included: increased BWT (>3 mm), bowel dilation (>25 mm) or stricture (<10 mm).


RESULTS
Ileocolonoscopy detected recurrence in 67/72 (93%) patients. SICUS detected findings compatible with recurrence in 62/72 (86%) patients (5 false negative (FN), 4 false positive (FP), 1 true negative (TN), 62 true positive (TP)), showing a 92.5% sensitivity, 20% specificity, and 87.5% accuracy for detecting CD recurrence. The BWT detected by SICUS was correlated with the Rutgeerts' score (P = 0.0001; r = 0.67). The median BWT, the extent of the ileal lesions, and the prestenotic dilation were higher in patients with an endoscopic degree of recurrence >or=3 versus <or=2 (P < 0.001) and the lumen diameter was lower in patients with a Rutgeerts' score >or=3 versus <or=2 (P < 0.0001).


CONCLUSIONS
: Although SICUS and ileocolonoscopy provide different views of the small bowel, SICUS shows a significant correlation with the endoscopic findings. SICUS may represent an alternative noninvasive technique for assessing CD recurrence after ileocolonic resection.
Calabrese
Emma
E
Dipartimento di Medicina Interna, Università di Roma Tor Vergata, Cattedra di Gastroenterologia, Rome, Italy.
Petruzziello
Carmelina
C
Onali
Sara
S
Condino
Giovanna
G
Zorzi
Francesca
F
Pallone
Francesco
F
Biancone
Livia
L
D000293:Adolescent; D000328:Adult; D000368:Aged; D003106:Colon / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy / Q000379:methods* / Q000592:standards; D003287:Contrast Media; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000473:pathology; D012008:Recurrence; D012015:Reference Standards; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014463:Ultrasonography / Q000379:methods* / Q000592:standards; D055815:Young Adult
D003287:Contrast Media