P414 Usefulness of ultrasonography in the assessment of postoperative recurrence of Crohn’s disease
M. Murakami*1, T. Kanemura1, A. Haga1, R. Kubota1, K. Yaguchi1, M. Nishio1, S. Tsuda1, T. Ogashiwa1, Y. Kogure1, K. Kasahara1, K. Hirai2, Y. Fukuno2, M. Jin2, A. Hanzawa2, H. Yonezawa2, K. Sakamaki3, K. Numata4, H. Kimura1, R. Kunisaki1
1Yokohama City University Medical Centre, Inflammatory Bowel Disease Centre, Yokohama, Japan, 2Yokohama City University Medical Centre, Department of Laboratory Medicine and Clinical Investigation, Yokohama, Japan, 3Graduate School of Medicine, Yokohama City University, Department of Biostatistics and Epidemiology, Yokohama, Japan, 4Yokohama City University Medical centre, Gastroenterology Centre, Yokohama, Japan
Prevention of reoperation is one of the main goals of postoperative management of Crohn’s disease (CD). Precise monitoring of disease activity is essential in detecting early postoperative recurrence. Endoscopy is the current gold standard for assessing postoperative recurrence of CD. However, ultrasonography (US) may become an alternative to endoscopy, as it is non-invasive, well accepted by patients, and has excellent spatial resolution. The aim of this study was to evaluate the usefulness of US in assessing postoperative recurrence of CD.
In total, 67 patients with CD who had previously undergone ileocolic resection underwent both US and colonoscopy (CS) within a 1-month period. US examination included evaluation of bowel wall thickness, bowel layer structure, and colour Doppler grade at the anastomosis level. Endoscopic recurrence at anastomosis was assessed using the Rutgeerts score, with recurrence defined as lesions greater than Grade 2 and severe lesions as Grades 3 and 4. The relations between endoscopy and US variables were assessed using the Mann–Whitney U-test and receiver operating characteristic (ROC) analysis.
Of 67 patients, 45 (67%) showed endoscopic recurrence (Rutgeerts score > 2), with 22 (33%) showing severe recurrence (Rutgeerts score > 3). The wall thickness cut-off point on US indicating best distinguished between recurrence and non-recurrence was 3.5 mm (82% sensitivity and 62% specificity). Wall thickness (p = 0.002), layer structure (p = 0.009), and colour Doppler grade (p = 0.015) on US showed significant relations with endoscopic recurrence. Optimum performance on US in detecting endoscopic recurrence was achieved with the combinations of wall thickness ≥ 3.5 mm and colour Doppler grade 2 or 3 (area under the curve [AUC] 0.805, p < 0.001) and layer structure disappearance and colour Doppler grade 2 or 3 (AUC 0.755, p = 0.001).
Combinations colour Doppler grade with bowel wall thickness and bowel layer structure were optimal in detecting recurrence. US may become an alternative to endoscopy in assessing the postoperative recurrence of CD.