Predictivity of early and late assessment for post-surgical recurrence of Crohn's disease: Data from a single-center retrospective series

Piaz, Giulia Dal; Mendolaro, M.; Mineccia, Michela; Randazzo, Claudia; Massucco, Paolo; Cosimato, M.; Rigazio, C.; Guiotto, Cristina; Morello, Enrico; Ercole, E.; Lavagna, A.; Rocca, Rodolfo; Ferrero, Alessandro

doi:10.1016/j.dld.2020.09.018

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…In accordance with the evidence of the POCER trial, ECCO guidelines suggest colonoscopy 6–12 months after surgery as the best approach to guide clinical management of CD after intestinal resection 12 . Further results have confirmed that the most informative evaluation is the one performed within one year and that late endoscopy (>36 months) has no prognostic value 23 …”

Section: Discussionmentioning

confidence: 72%

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Comparison of two strategies for the management of postoperative recurrence in Crohn’s disease patients with one clinical risk factor: A multicentre IG‐IBD study

Dragoni

Castiglione

Bezzio³

et al. 2023

UEG Journal

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Background The management of postoperative recurrence (POR) in Crohn's disease (CD) after ileo‐colonic resection is a highly debated topic. Prophylactic immunosuppression after surgery is currently recommended in the presence of at least one clinical risk factor. Objective Our aim was to determine whether early immunosuppression can be avoided and guided by endoscopy in CD patients with only one risk factor. Methods CD patients with only one risk factor for POR, including previous intestinal resection, extensive small intestine resection (>50 cm), fistulising phenotype, history of perianal disease, and active smoking, were retrospectively included. Two groups were formed based on whether immunosuppression was started immediately after surgery (“prophylaxis group”) or guided by endoscopy (“endoscopy‐driven group”). Primary endpoints were rates of any endoscopic recurrence (Rutgeerts ≥ i2a) and severe endoscopic recurrence (i4) within 12 months after surgery. Secondary outcomes were clinical recurrence rates at 6, 12 and 24 months after surgery. Results A total of 195 patients were enroled, of whom 61 (31.3%) received immunoprophylaxis. No differences between immunoprophylaxis and the endoscopy‐driven approach were found regarding any endoscopic recurrence (36.1% vs. 45.5%, respectively, p = 0.10) and severe endoscopic recurrence (9.8% vs. 15.7%, respectively, p = 0.15) at the first endoscopic evaluation. Clinical recurrence rates were also not statistically different (p = 0.43, p = 0.09, and p = 0.63 at 6, 12, and 24 months, respectively). Conclusions In operated CD patients with only one risk factor for POR, immediate immunoprophylaxis does not decrease the rate of early clinical and endoscopic recurrence. Prospective studies are needed to confirm our results.

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Section: Discussionmentioning

confidence: 72%

“…12 Further results have confirmed that the most informative evaluation is the one performed within one year and that late endoscopy (>36 months) has no prognostic value. 23 Both biologics and thiopurines may be used for POR prevention.…”

mentioning

confidence: 99%

Comparison of two strategies for the management of postoperative recurrence in Crohn’s disease patients with one clinical risk factor: A multicentre IG‐IBD study

Dragoni

Castiglione

Bezzio³

et al. 2023

UEG Journal

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“…More recently, a retrospective study ( 40 ), including 201 post-operative patients with CD followed for a median of 7.6 years, showed that IUS recurrence (defined as either anastomotic BWT > 4 mm or new abdominal complication) predicted surgical recurrence, i.e., new major abdominal surgery or symptoms not controlled by medical treatments, while endoscopic recurrence was not predictive of late clinical recurrence (after 36 months) and, thus lacks prognostic value.…”

Section: Resultsmentioning

confidence: 99%

The Impact of Intestinal Ultrasound on the Management of Inflammatory Bowel Disease: From Established Facts Toward New Horizons

et al. 2022

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Intestinal ultrasound (IUS) plays a crucial role as a non-invasive and accurate tool to diagnose and assess inflammatory bowel disease (IBD). The rationale for using IUS in Crohn’s disease (CD), a transmural disease, is widely acknowledged. While the use of IUS in ulcerative colitis (UC), a mucosal disease, is often underestimated, but, recently, it is increasingly expanding. In the context of a treat-to-target approach, the role of IUS is shifting toward a monitoring tool for predicting response to therapy. Hence, adjusting therapeutic strategies based on IUS response could reduce the burden related to endoscopy and speed the decision process with the ultimate goal to alter the natural course of IBD. Assessment of bowel wall thickness (BWT) is the most reliable IUS measure. However, the development of validated and reproducible sonographic scores to measure disease activity and the identification of parameters of therapeutic response remain relevant issues to implement the daily adoption of IUS in clinical practice. Accordingly, this review focuses on the current literature investigating the impact of IUS on CD with emphasis on the concept of transmural healing (TH) and the main related advantages. We further explore new insights on the role of IUS in UC and its clinical implications.

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“…Furthermore, in a 2021 retrospective study on 201 patients by Dal Piaz et al 48 , IUS recurrence and BWT ≥4 mm predicted surgical recurrence with an OR = 6.04 and 2.58, respectively. The latter results support the routine use of IUS and SICUS in clinical practice for POR detection within one year after surgery, especially in the first months, in order to detect early recurrence.…”

Section: Intrabdominal Fistulamentioning

confidence: 94%

Intestinal Ultrasound and its Application as Point-of-Care Procedure for Diagnosing and Detecting Inflammatory Bowel Disease and Related Complications: A Narrative Review

Rispo,

Testa,

Nardone

et al. 2023

MRAJ

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lapsing, inflammatory disease affecting the gastrointestinal tract and leading to chronic damage. Endoscopy with biopsies is considered the gold standard for inflammatory bowel disease diagnosis, whereas magnetic resonance for Crohn’s disease extension and complication assessment. However, colonoscopy is an invasive procedure, while magnetic resonance is relatively not easily accessible for patients; thus, the need for a reliable, accessible and non-invasive way to perform inflammatory bowel diseases diagnosis and monitoring in the tight control era, like intestinal ultrasound is. Compared to endoscopy and magnetic resonance, ultrasound has shown reliable diagnostic accuracy in assessing Crohn’s disease diagnosis and evaluation of localisation, extension and complications. On the other hand, intestinal ultrasound is emerging as a valid tool also for ulcerative colitis severity and extension assessment. Moreover, performing ultrasonography in a point-of-care setting can guide the clinician in driving the diagnostic and therapeutic pathway, thus accelerating clinical decisions. As a novelty, point-of-care intestinal ultrasound performed with pocket devices could represent a promising item for the future of physical examination in outpatient or inpatient examination. The need for reproducibility of intestinal ultrasound among sonographers has emerged as a key-point in inflammatory bowel disease research field: the development of new scores for the evaluation of disease severity together with an intensive dedicated trainship could potentially reduce the differences between clinicians reporting. Accordingly, our aim was to perform a narrative review about the application of intestinal ultrasound in Crohn’s disease and ulcerative colitis diagnosis and monitoring. Furthermore, technical aspects of this imaging technique and its application in a point-of-care setting through traditional and handheld sonographers were explored.

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Predictivity of early and late assessment for post-surgical recurrence of Crohn's disease: Data from a single-center retrospective series

Cited by 9 publications

References 32 publications

Comparison of two strategies for the management of postoperative recurrence in Crohn’s disease patients with one clinical risk factor: A multicentre IG‐IBD study

Comparison of two strategies for the management of postoperative recurrence in Crohn’s disease patients with one clinical risk factor: A multicentre IG‐IBD study

The Impact of Intestinal Ultrasound on the Management of Inflammatory Bowel Disease: From Established Facts Toward New Horizons

Intestinal Ultrasound and its Application as Point-of-Care Procedure for Diagnosing and Detecting Inflammatory Bowel Disease and Related Complications: A Narrative Review

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