Intestinal ultrasound picks up CD recurrence post-op

Intestinal ultrasound could be a simple, effective, and noninvasive tool for detecting the recurrence of Crohn’s disease (CD) after surgery, according to an expert at CCC 2022.

CD affects any segment of the intestinal tract. Despite available therapies, the majority of the patients require surgery within 10 years of diagnosis due to progressive bowel damage. Even when all macroscopic lesions have been completely removed by surgery, patients still have asymptomatic recurrence thereafter, prior to experiencing symptoms.

“Postoperative recurrence in the absence of treatment can go up to 90 percent within a year,” said study author Dr Michael Dolinger of the Icahn School of Medicine at Mount Sinai in New York City, New York, US. “Often, this is clinically silent. About 50 percent of the patients will need repeat surgery within 10 years after the first bowel resection.”

Post-operative colonoscopy ably detects inflammation and poor CD prognosis, but it is associated with poor compliance. “It is also without risk and not ideal for repeat monitoring if patients have ulcerations at the scope. Hence, a less invasive monitoring tool for recurrence following surgical resection is urgently needed,” said Dolinger.

He and his team sought to assess the accuracy of intestinal ultrasound in detecting the postoperative recurrence of CD in a cross-sectional pilot study conducted at their institution. Eighteen patients with CD (median age 29 years, 50 percent female) who underwent ileocolic resection (median 45 months post-resection) and intestinal ultrasound within 30 days of a planned colonoscopy were included in the analysis.

Intestinal ultrasound parameters that correlated with CD recurrence included neo-terminal ileum bowel wall thickness (4 mm vs 2 mm), ileocolic anastomosis hyperaemia (100 percent vs 20 percent), and neo-terminal hyperaemia (75 percent vs 0 percent) seen in eight patients who had an endoscopic recurrence.

“We have shown that a bowel wall thickness greater than 3.2 mm accurately detects endoscopic recurrence with great specificity, positive predictive value, negative predictive value, and an area under the curve of 0.82,” Dolinger reported.

Interestingly, traditional biomarkers for endoscopic disease activity such as Harvey Bradshaw Index, C-reactive protein, Endoscopic Healing Index, and faecal calprotectin were not associated with endoscopic recurrence.

The natural history of CD is characterized by a remitting and relapsing course, with a considerable number of patients ultimately requiring bowel resection. 

“Intestinal ultrasound is a feasible, accurate, and noninvasive tool for detecting postoperative CD recurrence. In fact, it may be more accurate than our traditional noninvasive biomarkers and clinical activity scores,” Dolinger said matter-of-factly. “The next step is to conduct prospective studies to assess how we can fit intestinal ultrasound into our monitoring of CD patients following resection, and eventually tailor the management.”