Diagnosis and monitoring of postoperative recurrence in Crohn’s disease

Abstract

Despite advances in medical management, many patients with Crohn’s disease (CD) require intestinal surgery throughout their lives. Surgery is not a cure, and postoperative recurrence is common in patients with CD. Ileocolonoscopy has been considered to be the gold standard in the diagnosis and monitoring of postoperative recurrence. However, the optimal monitoring strategy for postoperative recurrence has yet to be established. Capsule endoscopy and cross-sectional imaging techniques, including ultrasonography, computed tomography and MRI, have been used in the postoperative setting, and their usefulness in the monitoring of disease activity has been evaluated in recent clinical trials. The value of fecal markers, such as calprotectin and lactoferrin, has been also assessed in several studies. This review was to identify optimized methods for the diagnosis and monitoring of postoperative recurrence in CD.

Keywords:

• capsule endoscopy
• Crohn’s disease
• computed tomography
• fecal calprotectin
• fecal lactoferrin
• ileocolonoscopy
• MRI
• postoperative recurrence
• surgery
• ultrasonography

Financial & competing interests disclosure

The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Postoperative recurrence of Crohn’s disease (CD) is thought to be triggered by the presence of intestinal contents and bacteria in the bowel lumen that lead to mucosal invasion by inflammatory cells.

• Clinical recurrence tends to occur later than endoscopic recurrence, and many patients with clinically quiescent disease have endoscopically evident disease after surgery for CD.

• Ileocolonoscopy has been considered to be the gold standard in the diagnosis and monitoring of postoperative recurrence. The severity of the endoscopic lesions in the neo-terminal ileum during 6–12 months after ileocolonic resection appears to be a reliable predictor for future clinical recurrence.

• Wireless capsule endoscopy may be useful as a non-invasive technique for the assessment of CD recurrence, although further studies are needed.

• Ultrasonography is a non-invasive technique for identifying postoperative CD recurrence with favorable sensitivities and specificities. The degree of bowel wall thickness at the anastomosis is associated with the severity of endoscopic recurrence.

• Computed tomography enteroclysis and enterography are useful methods in the diagnosis of CD recurrence, and show agreement with the endoscopic score. These techniques may be useful for the prediction of clinical course of postoperative CD.

• Magnetic resonance enteroclysis and enterography can detect CD recurrence after ileocolonic resection, and are complimentary to ileocolonoscopy. They may be valuable in predicting the clinical course of patients with postoperative CD.

• 99mTc-HMPAO scintigraphy is a sensitive technique for the early detection of postoperative CD recurrence.

• Fecal calprotectin may be useful in monitoring disease activity, and in predicting future clinical course after surgery for CD.

• An optimal monitoring strategy for postoperative recurrence has yet to be established. Further studies are needed to identify optimized methods for the diagnosis and monitoring of postoperative CD recurrence.

Notes