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ROLE OF INTESTINAL ULTRASOUND IN THE DIAGNOSIS OF POST-OPERATIVE RECURRENCE IN CROHN’S DISEASE

Carmen Amor Costa 1, Cristina Suárez Ferrer 1, Joaquin Poza Cordón 1, Jorge Yebra Carmona 1, Jose Luis Rueda García 1, Maria Sanchez-Azofra 1, Eduardo Martín-Arranz 1, Katherine Silva 1, Clara Amiama Roig 1, Irene González Díaz 1, Laura Garcia Ramirez 1, María Dolores Martín-Arranz 1

Affiliations

1 La Paz University Hospital, School of Medicine, Universidad Autónoma de Madrid, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain

Summary

AI Generated

In a retrospective study of 103 Crohn's disease patients, intestinal ultrasound wall thickness and hyperemia correlated with endoscopic post-operative recurrence, but existing ultrasound activity scores did not discriminate between patients with and without recurrence.

Wall thickness and hyperemia (Limberg >1) both showed 89.0% sensitivity and 76.7% specificity for diagnosing post-operative recurrence defined as Rutgeerts score ≥i2b
Mean wall thickness was significantly greater in patients with post-operative recurrence (5.0 mm, SD ±1.7) compared to those without recurrence (2.7 mm, SD ±1.3), p=0.001
Three ultrasound activity scores (Simple US Score, SUS-CD, and IBUS-SAS) showed poor discrimination with AUC values of 48-51% and no statistical difference between patients with and without endoscopic recurrence
The authors conclude that new ultrasound scores specifically adapted to post-operative recurrence may be needed, as existing disease activity scores were not reliable in this setting

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Abstract

Introduction

Ileocolonoscopy and Rutgeerts endoscopic score remains the gold standard to evaluate post-operative recurrence (POR) in Crohn's disease (CD) patients (1).
Intestinal ultrasound (IUS) is proposed as a non-invasive alternative to ileocolonoscopy for the diagnosis of POR, with a sensitivity of 94% and specificity of 84% (2). There are several IUS scores that evaluate CD disease activity such as SUS-CD (validated), IBUS-SAS and Simple US Score, which have not yet been studied in the diagnosis of POR.

Aims & Methods

The aim of this study is to assess whether IUS parameters and ultrasound scores correlate with endoscopy in the diagnosis of POR. A unicentric retrospective study was performed. There were included patients with CD with both an ileocolonoscopy and intestinal ultrasound performed for the detection of POR, the time between tests was less than 6 months and there was no therapeutic change between tests.
Endoscopic POR was evaluated with Rutgeers score (RS), considering POR RS ≥i2b. In IUS, were used: Simple US Score, SUS-CD and IBUS-SAS.

Results

103 patients were included, the Montreal classification was: A1 n=6 (5.8%), A2 n=78 (75.7%), A3 n=18 (17.5%), L1 n=54 (52.4%), L2 n=2 (1.9%), L3 n=47 (50.6%), B1 n=10 (9.7%), B2 n=49 (47.6%) and B3 n=44 (42.7%).
30 patients (29.1%) had no endoscopic POR, 22 (21.4%) had RS i2a, 12 (11.6%) RS i2b and 39 (37.9%) had severe POR (RS i3-i4). The mean wall thickness measured by IUS in patients without endoscopic POR was 2.7 mm (SD +/- 1.3) versus 5.0 (SD +/- 1.7) in patients with RS ≥i2b (p 0.001). Hyperemia (Limberg >1) was present in 60 patients (82.2%) with RS ≥i2a vs in 4 patients (13.3%) without endoscopic POR (p 0.001). Both hyperemia and wall thickness had a sensitivity of 89.0% and specificity of 76.7% in the diagnosis of POR.
The mean values for IUS scores were: Simple US Score 5.5 (SD +/- 3.1), SUS-CD 2.1 (SD +/- 1.8) and IBUS-SAS 32.9 (SD +/- 26.3). There weren’t statistical differences between IUS scores in patients with RS <i2b and ≥i2b. Simple US Score had an area under the ROC curve (AUC) of 51%, IBUS-SAS presented an AUC of 48.4% and SUS-CD of 48.5%.

Conclusion

In our experience wall thickness and hyperemia are useful parameters to diagnosis POR, however IUS scores (IBUS-SAS, SUS-CD and Simple US Score) are less reliable. In the future new scores adapted to POR may be needed.

References

1. Domènech E, López-Sanromán A, Nos P, Vera M, Chaparro M, Esteve M, et al., Recommendations of the Spanish Working Group on Crohn’s Disease and Ulcerative Colitis (GETECCU) on the monitoring, prevention and treatment of post-operative recurrence in Crohn’s disease. Gastroen- terol Hepatol (English Ed [Internet]. 2017 Aug;40:472-83. Disponible en: https://linkinghub.elsevier.com/retrieve/pii/ S2444382417301190.
2. Rispo A, Imperatore N, Testa A, Nardone OM, Luglio G, Caporaso N, et al. Diagnostic accuracy of ultrasonography in the detec- tion of postsurgical recurrence in Crohn’s disease: A systematic review with meta-analysis. Inflamm Bowel Dis. 2018;24:977-88.

Disclosure

No conflict of interest

Conference

UEG Week Copenhagen 2023

Topics

IBD

Submission format

Abstract

Session

PP 05 IBD (Posters)

Citation

United European Gastroenterology Journal 2023; 11 (Supplement 8)

Published

2023

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