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P172 Postoperative recurrence of Crohn's disease: correlation between endoscopy and bowel ultrasound

J. Yebra Carmona*1, C. Suárez Ferrer1, J. Poza Cordón1, J. L. Rueda García1, J. Lucas Ramos1, I. Andaluz García1, E. Martín Arranz1, S. Gómez Senent1, M. D. Martín Arranz1, P. Mora Sanz1

1La Paz Hospital, Gastroenterology, Madrid, Spain

Background

Postoperative Crohn’s disease recurrence (POR) is currently assessed by ileocolonoscopy. B-mode bowel sonography (US) is an alternative, non-invasive, non-ionising and well tolerated diagnostic method. Our aim was to validate US, and to establish a correlation between the different ultrasound parameters of activity and Rutgeerts endoscopic score

Methods

We selected 31 patients with Crohn’s disease in follow-up at our unit, who had underwent surgical ileocolic resection, which performed ileocolonoscopy and US for the diagnosis of POR, with a difference between both tests lesser than 6 months. Recurrence was assessed by ileocolonoscopy using the Rutgeerts score, considering: i0–i1 absence of recurrence; ≥i2 endoscopic recurrence. The echographic findings were bowel wall thickness (BWT), hyperaemia, layer pattern, involvement of the mesenteric fat, presence of adenopathy and transmural complications (fistulas and abscesess).

Results

Clinical characteristics of the study population are reported in Table 1.

Female16 (51%)
Age at diagnosisA1 2 (6,7%); A2 22 (73.3%); A3 6 (20%)
Disease locationL1 14 (45.2%); L2 0(0%); L3 17 (54.8%)
Illness behaviour at diagnosisB1 3 (9.7%); B2 17(54.8%); B3 11 (35.5%)
Smoke habitSmoker 9 (29%); ex-smoker 14 (45%); non-smoker 8 (26%)
Number of surgical resectionone: 27 (87%); two: 4 (13%)
Treatmentnon 6(20%); azathioprine 5 (16%); anti-TNF 8 (26,7%); combined 11 (36%)
Rutgeerts scoreio–i1: 11 (35.5%); i2: 10 (32%); i3–i4: 10 (32%)
Endoscopic recurrence≥i2: 20 (64,5%)
Faecal calprotectin>50 ng/mg: 18 (58%)

Main demographic, clinical characteristics according to Montreal classification.

Ileoconoloscopy detected recurrence in 20 of 31 patients (64%). A statistically significant association was identified between wall thickness and recurrence (i ≥ 2) (mean 2.5 mm non recurrence vs. 5.2 mm recurrence, p = 0.002). A relationship was observed between Rutgeerts endoscopic score and BWT: 2.5 mm (SD 0.39) for i0–i1; 3.68 mm (SD 0.33) for i2 and 6.79 mm (SD 0.29) for i3–i4. However, this relationship did not reach statistical significance (p = 0.57). To establish the relationship between each of the ultrasound variables with the endoscopic recurrence, a multi-variate analysis was performed using logistic regression. It was identified that a BWT< 3 mm is associated with the possibility of endoscopic recurrence with a relative risk reduction (RRR) of 2.03, the preservation of the layer pattern RRR = 1.05, the absence of involvement of mesenteric fat RRR = 38.15 and the absence of adenopathies RRR = 1.23 (p = 0.003). ROC curve analysis (image 2) shows a BWT of 2.8 mm as the best cut-off point (SE: 95% ES: 82% AUC: 90%) to discriminate patients without recurrence (i < 2). For BWT > 3 mm, the classic parameter, shows SE: 90% ES: 82% AUC: 87%

ROC curve analysis

Conclusion

There is a good relationship between the different echographic parameters of activity (bowel thickness, hyperaemia, wall distortion, etc.) and the presence of endoscopic recurrence, as well as the severity of the recurrence.