P189 Serial monitoring of faecal calprotectin for the assessment of endoscopic recurrence in asymptomatic patients after ileocolonic resection for Crohn’s disease: a long-term prospective study
T. Yamamoto*, T. Shimoyama, S. Umegae, K. Matsumoto
Yokkaichi Hazu Medical Centre, Inflammatory Bowel Disease Centre, Yokkaichi, Japan
Ileocolonoscopy is recommended to be performed within 1 year after resection for Crohn’s disease (CD). Nevertheless, optimal monitoring strategies for recurrence after the ileocolonoscopy have yet to be established. Although an ideal approach may be to repeat ileocolonoscopy, endoscopy is a time-consuming and invasive procedure. Simple and non-invasive methods for the detection of postoperative recurrence are desirable. Calprotectin is a neutrophil-derived protein that is stable in faeces and can be detected in small stool samples. Faecal calprotectin (FC) showed a close correlation with endoscopic inflammation in patients with inflammatory bowel disease. However, to our knowledge, no studies have consecutively measured the levels of FC after resection for CD. This prospective study was to evaluate the value of serial monitoring of FC after the ileocolonoscopy for the assessment of endoscopic recurrence in asymptomatic patients.
Asymptomatic patients without endoscopic recurrence at ileocolonoscopy 6–12 months after ileocolonic resection were studied. FC levels were measured every 2 months up to 24 months after the ileocolonoscopy. When FC level was elevated (≥ 140 µg/g), a second ileocolonoscopy was immediately undertaken. In contrast, patients who maintained low FC levels (< 140 µg/g) during the 24-month follow-up underwent a second ileocolonoscopy at the end of the study. Endoscopic recurrence was defined as a Rutgeerts score ≥vi2.
In total, 30 patients were studied. In 8 patients, FC level was raised during the 24-month follow-up. Six of the 8 patients (75%) had endoscopic recurrence. Of 22 patients who maintained low FC levels, 20 (91%) had no endoscopic recurrence, whereas 2 showed endoscopic recurrence at the end of the follow-up. The diagnostic accuracy of FC ≥ 140 µg/g to detect endoscopic recurrence was 87%.
Consecutive monitoring of FC is useful for the assessment of endoscopic recurrence after the initial ileocolonoscopy. Increased FC levels indicate a need for repeat ileocolonoscopy, whereas sustained low FC levels predict a low risk of endoscopic recurrence. In patients maintaining low FC levels, unnecessary invasive endoscopic examinations can be avoided.