Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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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

  • Choi, In Young (Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine) ;
  • Park, Sang Hyoung (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Park, Seong Ho (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Yu, Chang Sik (Department of Colorectal Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Yoon, Yong Sik (Department of Colorectal Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Lee, Jong Lyul (Department of Colorectal Surgery, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Ye, Byong Duk (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Kim, Ah Young (Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center) ;
  • Yang, Suk-Kyun (Department of Gastroenterology, University of Ulsan College of Medicine, Asan Medical Center)
  • Received : 2017.02.22
  • Accepted : 2017.05.17
  • Published : 2017.12.01
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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, $31.4{\pm}9.6$ 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 ${\geq}150$ 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 ${\geq}150$, except that CTE yield for extraluminal penetrating complications was significantly higher in CDAI ${\geq}150$ (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.

Keywords

References

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