Doppler Activity and Ultrasonographic Detection of Intra-Abdominal Fistulas Are Predictors of Surgery in Crohn’s Disease

Abstract

<b><i>Bakground and Aim:</i></b> Predictors of the need for surgery in sticturing Crohn’s disease (SCD) are lacking. Bowel ultrasound (US) is a harmless, noninvasive, and inexpensive diagnostic procedure that has proven to be a valuable tool in the management of Crohn’s disease (CD). Our aim was to identify ultrasonographic findings in SCD that may associate with a higher risk of surgery, allowing us to make early choices regarding treatment election in this specific group of patients. <b><i>Materials and Methods:</i></b> This was a retrospective, case-control study. Twenty-four patients diagnosed with SCD between 2013 and 2017 with a past history of stricture-related surgery were included and then matched with 46 non-operated controls. Prior US from patients in both groups were analyzed. US features considered for analysis were as follows: bowel wall thickness, degree of parietal vascularization (measured by Doppler activity), prestenotic dilation, involvement of mesenteric fat, and newly detected concomitant fistulas or abscess. <b><i>Results:</i></b> Doppler activity (<i>p</i> < 0.001), enteroenteric fistulas (<i>p</i> = 0.04), enteromesenteric fistulas (<i>p</i> = 0.003), and associated abscess (<i>p</i> = 0.004) were significantly associated with the need for surgery in the short-term period. Multivariate analysis showed strong association of these features with the risk of surgery but failed to reach statistical significance. <b><i>Conclusion:</i></b> US features may potentially be used as point-of-care tools to aid clinicians in the assessment of the surgical risk in patients with SCD.

Diagnostic Accuracy of Intestinal Ultrasound in the Detection of Intra-Abdominal Complications in Crohn’s Disease: A Systematic Review and Meta-Analysis

“… 31 Garcia et al reported that entero-enteric fistulas [ p = 0.04] and entero-mesenteric tracts [ p = 0.003], detected by IUS, were significantly associated with the need for surgery in the short term. 66 …”

Novelties and Perspectives of Intestinal Ultrasound in the Personalised Management of Patients with Inflammatory Bowel Diseases—A Systematic Review

“…This can be defined as the need for medication escalation, use of corticosteroids, hospitalisation due to symptomatic disease, or major surgery for complications associated with CD. Pathological BWT and the presence of BWF have been associated with negative disease evolution, while the presence of at least one complication at baseline IUS increases the risk of surgery [7,19,28,53].…”