Salam P Bachour1, Ravi S Shah2, Ruishen Lyu3, Takahiro Nakamura4, Michael Shen4, Terry Li4, Bari Dane5, Edward L Barnes6, Florian Rieder7, Benjamin Cohen7, Taha Qazi7, Bret Lashner7, Jean Paul Achkar7, Jessica Philpott7, Stefan D Holubar8, Amy L Lightner8, Miguel Regueiro7, Jordan Axelrad9, Mark E Baker10, Benjamin Click11. 1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, Ohio. 2. Cleveland Clinic Department of Internal Medicine, Cleveland, Ohio. 3. Cleveland Clinic Department of Quantitative Health Sciences, Cleveland, Ohio. 4. New York University Department of Internal Medicine, New York, New York. 5. New York University Department of Radiology, New York, New York. 6. University of North Carolina at Chapel Hill, Division of Gastroenterology and Hepatology, Chapel Hill, North Carolina. 7. Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio. 8. Cleveland Clinic Department of Colorectal Surgery, Cleveland, Ohio. 9. New York University Department of Gastroenterology and Hepatology, New York, New York. 10. Cleveland Clinic Imaging Institute, Cleveland, Ohio. 11. Cleveland Clinic Department of Gastroenterology, Hepatology, and Nutrition, Cleveland, Ohio. Electronic address: clickb@ccf.org.
Abstract
BACKGROUND & AIMS: Postoperative Crohn's disease (CD) surveillance relies on endoscopic monitoring. The role of cross-sectional imaging is less clear. We evaluated the concordance of cross-sectional enterography with endoscopic recurrence and the predictive ability of radiography for future CD postoperative recurrence. METHODS: We performed a multi-institution retrospective cohort study of postoperative adult patients with CD who underwent ileocolonoscopy and cross-sectional enterography within 90 days of each other following ileocecal resection. Imaging studies were interpreted by blinded, expert CD radiologists. Patients were categorized by presence of endoscopic postoperative recurrence (E+) (modified Rutgeerts' score ≥i2b) or radiographic disease activity (R+) and grouped by concordance status. RESULTS: A total of 216 patients with CD with paired ileocolonoscopy and imaging were included. A majority (54.2%) exhibited concordance (34.7% E+/R+; 19.4% E-/R-) between studies. The plurality (41.7%; n = 90) were E-/R+ discordant. Imaging was highly sensitive (89.3%), with low specificity (31.8%), in detecting endoscopic postoperative recurrence. Intestinal wall thickening, luminal narrowing, mural hyper-enhancement, and length of disease on imaging were associated with endoscopic recurrence (all P < .01). Radiographic disease severity was associated with increasing Rutgeerts' score (P < .001). E-/R+ patients experienced more rapid subsequent endoscopic recurrence (hazard ratio, 4.16; P = .033) and increased rates of subsequent endoscopic (43.8% vs 22.7%) and surgical recurrence (20% vs 9.5%) than E-/R- patients (median follow-up, 4.5 years). CONCLUSIONS: Cross-sectional imaging is highly sensitive, but poorly specific, in detecting endoscopic disease activity and postoperative recurrence. Advanced radiographic disease correlates with endoscopic severity. Patients with radiographic activity in the absence of endoscopic recurrence may be at increased risk for future recurrence, and closer monitoring should be considered.
BACKGROUND & AIMS: Postoperative Crohn's disease (CD) surveillance relies on endoscopic monitoring. The role of cross-sectional imaging is less clear. We evaluated the concordance of cross-sectional enterography with endoscopic recurrence and the predictive ability of radiography for future CD postoperative recurrence. METHODS: We performed a multi-institution retrospective cohort study of postoperative adult patients with CD who underwent ileocolonoscopy and cross-sectional enterography within 90 days of each other following ileocecal resection. Imaging studies were interpreted by blinded, expert CD radiologists. Patients were categorized by presence of endoscopic postoperative recurrence (E+) (modified Rutgeerts' score ≥i2b) or radiographic disease activity (R+) and grouped by concordance status. RESULTS: A total of 216 patients with CD with paired ileocolonoscopy and imaging were included. A majority (54.2%) exhibited concordance (34.7% E+/R+; 19.4% E-/R-) between studies. The plurality (41.7%; n = 90) were E-/R+ discordant. Imaging was highly sensitive (89.3%), with low specificity (31.8%), in detecting endoscopic postoperative recurrence. Intestinal wall thickening, luminal narrowing, mural hyper-enhancement, and length of disease on imaging were associated with endoscopic recurrence (all P < .01). Radiographic disease severity was associated with increasing Rutgeerts' score (P < .001). E-/R+ patients experienced more rapid subsequent endoscopic recurrence (hazard ratio, 4.16; P = .033) and increased rates of subsequent endoscopic (43.8% vs 22.7%) and surgical recurrence (20% vs 9.5%) than E-/R- patients (median follow-up, 4.5 years). CONCLUSIONS: Cross-sectional imaging is highly sensitive, but poorly specific, in detecting endoscopic disease activity and postoperative recurrence. Advanced radiographic disease correlates with endoscopic severity. Patients with radiographic activity in the absence of endoscopic recurrence may be at increased risk for future recurrence, and closer monitoring should be considered.
Authors: Rosel Sturkenboom; Daniel Keszthelyi; Lloyd Brandts; Zsa Zsa R M Weerts; Johanna T W Snijkers; Ad A M Masclee; Brigitte A B Essers Journal: Qual Life Res Date: 2021-09-21 Impact factor: 4.147