Transabdominal Intestinal Ultrasound Reduces Risk of Post-Operative Crohn’s Disease

Bowel wall thickness and hyperemia in the neo-terminal ileum and bowel wall hyperemia at the ileocolic anastomosis were the only IUS parameters linked to endoscopic recurrence.

There remains a need for non-invasive options to replace colonoscopies for patients with Crohn’s disease.

A team, led by Michael T. Dolinger, MD, Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, assessed the accuracy of transabdominal intestinal ultrasounds (IUS) for endoscopic recurrence in patients with Crohn’s disease in data presented during the Crohn’s and Colitis Congress 2022 Annual Meeting.

Colonscopies

Colonoscopy is considered the best option for the detection of endoscopic recurrence following an ileocolic resection in patients with Crohn’s disease. However, colonoscopies can be invasive and not always accepted by patients for repeated monitoring.

Transabdominal intestinal ultrasounds can be a non-irradiating, non-invasive, and easy to repeat option to replace colonoscopies.

In the cross-sectional trial, the investigators examined patients with Crohn’s disease who underwent point-of-care transabdominal intestinal ultrasounds during a postoperative follow-up clinic within 30 days of a planned colonoscopy. The parameters of the procedure included bowel wall thickness, bowel wall hyperemia, layer stratification, inflammatory fat, lymphadenopathy, and complications.

They also measured C-reactive protein, fecal calprotectin, endoscopic healing index (EHI), and Harvey Bradshaw Index. Endoscopic recurrence was defined as a Rutgeerts Score of greater than i2.

The investigators sought primary outcomes of the association between IUS parameters and endoscopic recurrence. They also sought secondary outcomes of the association of IUS parameters with other markers of disease activity.

Results

The team used univariable analysis, including Fisher’s exact, Wilcoxon Rank Sum, and Spearman correlation coefficient to test associations with endoscopic recurrence and determined optimal cut-off values for bowel wall thickness to accurately identify endoscopic recurrence using area under the receiver operator curve figures.

Overall, the investigators examined 18 patients with Crohn’s disease between 19-40 years who underwent IUS examination between 29-99 months post-ICR.

Every patient underwent endoscopy within 30 days of examination, with 22% (n = 4) for the first time post-ICR. In addition, 39% (n = 7) of patients were treated with ustekinumab, 22% (n = 4) were treated with adalimumab, 11% (n = 2) were treated with infliximab, 6% (n = 1) were treated with vedolizumab, and 22% (n = 4) were on no therapy.

Endoscopic recurrence occurred in 44% (n = 8) of patients and bowel wall thickness and hyperemia in the neo-terminal ileum and bowel wall hyperemia at the ileocolic anastomosis were the only IUS parameters linked to endoscopic recurrence.

Bowel wall thickness was 4.0 mm in patients with endoscopic recurrence, compared to 2.0 mm in those without (P = 0.04), while bowel wall thickness of 3.2 mm was the optimal curt point for predicting endoscopic recurrence with an AUROC of 0.82, positive predictivities value of 100%, negative predictive value of 97.3%, sensitivity of 75%, and specificity of 100%, compared to a CRP of 10.4 mg/L (AUROC = 0.54) or FC of 1146 μg/g (AUROC = 0.56).

There were significant correlations observed between neo-terminal ileum bowel wall thickness and Rutgeerts score (P = 0.51; P = 0.04) and between bowel wall thickness and CRP (P = -0.56; P = 0.023). This was not true for bowel wall thickness and fecal calprotectin (P = -0.04; P = 0.91), bowel wall thickness and endoscopic healing index (P = -0.04; P = 0.91) or bowel wall thickness and HBI (P = 0.09; P = 0.75).

“IUS is a feasible, accurate, non-invasive monitoring tool for detection of postoperative CD recurrence,” the authors wrote. “Larger prospective studies are needed to determine how IUS can be integrated in the monitoring of CD patients after surgery.”

The study, “POINT-OF-CARE INTESTINAL ULTRASOUND FOR THE DETECTION OF POSTOPERATIVE CROHN'S DISEASE ENDOSCOPIC RECURRENCE,” was published online by the Crohn’s and Colitis Congress.