Endoscopic vs ultrasonographic findings related to Crohn's Disease recurrence: A prospective longitudinal study at 3years
Received 7 November 2009; received in revised form 20 December 2009; accepted 20 December 2009. published online 22 February 2010. Corrected Proof
Abstract
Background and aims
Ileocolonoscopy (IC) is the gold standard for assessing Crohn's Disease (CD) recurrence after ileo-colonic resection. In a prospective longitudinal study we compared findings related to CD recurrence when using techniques visualizing either the luminal or the extraluminal surface (IC and small bowel follow through, SBFT vs Small Intestine Contrast Ultrasonography, SICUS).
Methods
From 2003 to 2008, 25 CD patients undergoing ileo-colonic resection were enrolled. Clinical assessment (CDAI) was performed at 1, 2 and 3years. IC was performed at 1 (n=25) and 3years (n=15), SBFT at 2years (n=21) and SICUS at 1 (n=25), 2 (n=21) and 3years (n=15). Recurrence was assessed by SBFT and SICUS (bowel wall thickness, BWT) when using IC as gold standard.
Results
At 1year, all patients were inactive and recurrence was detected by IC in 24/25 (96%) and by SICUS in 25/25 patients. At 2years, 6/21 patients (29%) were active and recurrence was detected by SBFT in 12/21 (57%) and by SICUS in 21/21 patients. At 3years, 5/15 patients (33%) were active, IC showed recurrence in 14/15 (93%), and SICUS in 15/15 patients. The endoscopic score at 1year was higher in patients developing relapse at 2years (n=5) than in patients maintaining remission (n=10) (median: 4, range 3–4 vs 2, range 0–3; p=0.003). The same finding was not observed by using SICUS (median BWT at 1year: 5, range 4–7 vs 3.7, range 3.5–6; p=0.19).
Conclusions
Although IC and SICUS provide a different view of the bowel wall, in experienced hands SICUS provides findings compatible with endoscopic recurrence after ileo-colonic resection for CD. Discrepant findings may be observed in a low proportion of patients with minor lesions related to CD recurrence.
ABSTRACT
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