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KMID : 0880420170180060906
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Korean Journal of Radiology
2017 Volume.18 No. 6 p.906 ~ p.914
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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
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Choi In-Young
Park Sang-Hyoung
Park Seong-Ho
Yu Chang-Sik
Yoon Yong-Sik
Lee Jong-Lyul
Ye Byong-Duk
Kim Ah-Young
Yang Suk-Kyun
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Abstract
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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 ± 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 ≥ 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 ≥ 150, except that CTE yield for extraluminal penetrating complications was significantly higher in CDAI ≥ 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.
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KEYWORD
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Crohn's disease, Ileocolonic, Intestine, Follow-up, CT enterography, CTE, Monitor, Recurrent, Asymptomatic
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