CT Enterography for Surveillance of Anastomotic Recurrence within 12 Months of Bowel Resection in Patients with Crohn's Disease: An Observational Study Using an 8-Year Registry.
10.3348/kjr.2017.18.6.906
- Author:
In Young CHOI
1
;
Sang Hyoung PARK
;
Seong Ho PARK
;
Chang Sik YU
;
Yong Sik YOON
;
Jong Lyul LEE
;
Byong Duk YE
;
Ah Young KIM
;
Suk Kyun YANG
Author Information
1. Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan 15355, Korea.
- Publication Type:Original Article
- Keywords:
Crohn's disease;
Ileocolonic;
Intestine;
Follow-up;
CT enterography;
CTE;
Monitor;
Recurrent;
Asymptomatic
- MeSH:
Adult;
Crohn Disease*;
Female;
Follow-Up Studies;
Humans;
Intestines;
Male;
Observational Study*;
Recurrence*;
Risk Factors;
Sensitivity and Specificity
- From:Korean Journal of Radiology
2017;18(6):906-914
- CountryRepublic of Korea
- Language:English
-
Abstract:
OBJECTIVE: To investigate the diagnostic yield and accuracy of CT enterography (CTE) for early (< 12 postoperative months) surveillance of anastomotic recurrence after bowel resection for Crohn's disease (CD). MATERIALS AND METHODS: We analyzed 88 adults (60 males and 28 females; mean age, 31.4 ± 9.6 years) who underwent bowel surgery for CD that created ileocolic anastomosis without enteric stoma, and underwent CTE for surveillance of CD recurrence/aggravation within 12 post-operative months. The CD activity index (CDAI) at the time of CTE was < 150 (i.e., clinically silent) in 51 patients, and ≥ 150 in 37 patients. Diagnostic yields of CTE regarding CD recurrence in the ileocolic anastomosis and extraluminal penetrating complications were determined. CTE-related step-up therapy was recorded. These outcomes were compared between the two CDAI groups after accounting for major risk factors for CD recurrence. In a subgroup of 31 patients who underwent both CTE and ileocolonoscopy within 1 month, CTE accuracy for anastomotic recurrence was assessed using the Rutgeerts scoring as the reference standard. RESULTS: CTE diagnostic yield was 35.2% (31/88) for the anastomotic recurrence and 9.1% (8/88) for penetrating complications. 20.5% (18/88) of the patients underwent step-up therapy after CTE detection of anastomotic recurrence. These outcomes were not significantly different between CDAI < 150 and CDAI ≥ 150, except that CTE yield for extraluminal penetrating complications was significantly higher in CDAI ≥ 150 (16.2% [6/37] vs. 3.9% [2/51]; multivariable-adjusted p = 0.029). CTE showed 92.3% (12/13) sensitivity and 83.3% (15/18) specificity for anastomotic recurrence. CONCLUSION: CTE may be a viable option for the early postsurgical surveillance of recurred disease in CD patients.
