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P081. Post surgical recurrence in patients with Crohn's disease: Accuracy of abdominal ultrasonography with oral contrast enhancement performed six months after surgery

M. Olivo1, F. Mocciaro1, R. Virdone1, G. Fusco1, A. Orlando1, L. Montalbano2, M. Giunta2, S. Renna1, E. Sinagra1, M. Cottone1

1Division of Internal Medicine “Villa Sofia-V. Cervello” Hospital, Palermo University, Palermo, Italy; 2Gastroenterology Unit “Villa Sofia-V. Cervello” Hospital, Palermo University, Palermo, Italy

Aim: Post-surgical recurrence is a frequent finding (70–80% at one year) in patients (pts) with Crohn's disease (CD). Previous studies assessed that severe endoscopic recurrence was correlated with a higher risk of clinical recurrence within 4 years. Bowel ultrasonography with oral contrast enhancement (SICUS), performed 1 year after surgery, is an accurate tool concerning the detection of disease recurrence. The aim of this study was to evaluate the diagnostic accuracy of SICUS, performed 6 months after surgery, for post surgical recurrence.

Materials and Methods: We prospectively evaluated pts who underwent surgery for CD between April 2005 and March 2010. Endoscopy and SICUS were performed 6 months after surgery. The post-surgical recurrence was classified according the Rutgeerts endoscopic score. SICUS (ingestion of 750 ml of polyethylene glycol solution) was considered suggestive for post-surgical recurrence in the presence of bowel wall thickness ≥ 3 mm. The abdomen was scanned starting from the right iliac fossa. Sensitivity, specificity, positive and negative predictive values were calculated using endoscopy as the gold standard.

Results: We evaluated 51 pts (males) operated on for ileo-cecal resection. Twenty-eight pts had a latero-lateral anastomosis, 7 had a termino-lateral anastomosis and 6 had a termino-terminal anastomosis. Twenty-six pts (50%) out of 51 had an endoscopic evidence of disease recurrence six month after surgery. A severe post surgical recurrence (Rutgeerts i3-i4) was present in 21/26 pts (81%). Sensitivity, specificity, positive and negative predictive values were respectively 61.5% (95% IC: 41–79%), 96% (95% IC: 78–100%), 94%, and 71% for SICUS. Considering only the grade i4, SICUS showed respectively sensitivity 78%, specificity 97%, positive predictive value 93% and negative predictive value of 89%. In case of disease recurrence at the SICUS, the probability to find a grade i4 was significantly higher respect to the lower grades (p value = 0.001). No differences in terms of sensitivity were found between the different anastomosis types.

Conclusion: Our pilot study showed that SICUS, performed 6 months after ileo-cecal resection in CD pts, at variance with other studies, had lower sensitivity for the diagnosis of post surgical recurrencebut a higher specificity. The sensitivity increased considering the grade i4. SICUS, performed 6 months after surgery, could be a no invasive procedure to detect (good sensitivity and high specificity) pts with early severe post surgical recurrence.