title: Crohn's disease recurrence in patients with ileocolic anastomosis: value of computed tomography enterography with water enema.
abstract: OBJECTIVE
  The main objective of the present work was to determine the diagnostic value of CT-enterography with water enema (CTe-WE) in the assessment of the ileocolic anastomosis in patients with Crohn's disease (CD). The prevalence of synchronous inflammatory lesions (SILs) involving gastrointestinal segments distinct from the anastomosis was also determined. Further, the association between the type of ileocolic anastomosis and the behavior (i.e. inflammatory, stricturing, penetrating) of CD recurrence was evaluated.
  
  
  METHODS
  51 patients were retrospectively included (26 [51%] male and 25 [49%] female; mean age: 52.88 years ± 13.35). Ileocolic anastomoses were: 18 (35.3%) stapled side-to-side, 17 (33.3%) end-to-side, and 16 (31.4%) end-to-end. CTe-WEs were reviewed in consensus by two gastrointestinal radiologists. Endoscopy and medical records were used as reference standards.
  
  
  RESULTS
  CTe-WE yielded 95.35% sensitivity (CI 95%: 84.19-99.43%), 75.00% specificity (CI 95%: 34.91-96.81%), and 92.15% diagnostic accuracy (CI 95%: 81.31-98.02%). Anastomotic recurrence was found in 41/51 (80.4%) patients, including 30/41 (73.2%) cases of isolated anastomotic recurrence, and 11/41 (26.8%) cases of anastomotic recurrence with a SIL. A significant lower prevalence of stricturing recurrence was observed in patients with stapled side-to-side anastomoses (p=0.033).
  
  
  CONCLUSIONS
  CTe-WE provides a good distension of both sides of ileocolic anastomoses allowing the detection of SILs.
authors.affiliation: Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Paparo
authors.forename: Matteo
authors.initials: M
authors.lastname: Revelli
authors.forename: Cristina
authors.initials: C
authors.lastname: Puppo
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Bacigalupo
authors.forename: Isabella
authors.initials: I
authors.lastname: Garello
authors.forename: Alessandro
authors.initials: A
authors.lastname: Garlaschi
authors.forename: Ennio
authors.initials: E
authors.lastname: Biscaldi
authors.forename: Ludovica
authors.initials: L
authors.lastname: Rollandi
authors.forename: Gian Andrea
authors.initials: GA
authors.lastname: Binda
authors.forename: Gian Andrea
authors.initials: GA
authors.lastname: Rollandi
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects*; D003106:Colon / Q000601:surgery; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000209:etiology*; D004733:Enema; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011856:Radiographic Image Enhancement / Q000379:methods*; D012008:Recurrence; D012086:Reoperation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014867:Water
chemical_list: D014867:Water
keywords: Computed tomography; Crohn's disease; Inflammatory bowel diseases; Recurrence; Surgical anastomosis