Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings
Autor(a) principal: | |
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Data de Publicação: | 2022 |
Outros Autores: | , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://hdl.handle.net/10316/104596 https://doi.org/10.1159/000517999 |
Resumo: | Endoscopy remains the exam of choice in the evaluation of activity in Crohn's disease (CD) after surgery (ACD-AS). However, intestinal ultrasound (IUS) may represent a noninvasive alternative. The objective of this study is to determine the diagnostic accuracy of this modality compared to endoscopy. Material and Methods: This is a crosssectional study, comprising a period of 14 months, carried out in patients with established CD and ileocecal resection due to the disease. IUS (HI-VISION Avius®, Tokyo, Japan) was performed with linear probe B-mode/Doppler prior to ileocolonoscopy. IUS and ileocolonoscopy were performed on the same day by 2 specialists in Gastroenterology dedicated to ultrasound and inflammatory bowel disease, in a doubleblind mode. Collected demographic and clinical data (Harvey- Bradshaw Index [HBI]; remission ≤4), serological/fecal inflammatory parameters (leukocytes [4–10 × 109 cells/L], Creactive protein [≤0.5 mg/dL], and fecal calprotectin [<50 mg/kg]), endoscopy (Rutgeerts score: remission <i2), and ultrasound (intestinal wall thickening [≤3 mm] and digestive wall vascularization using the semiquantitative score of Limberg [absent = 0, sparse = 1, moderate = 2, and marked = 3]). Results: Thirty-nine patients (female: 64.1%, mean age: 43.5 ± 15.3 years) were included. The median post-surgery follow- up was 9 years (IQR 3–12). The Montreal classification was as follows: L1, 61.5% (n = 24); L3, 38.5% (n = 15); B1 and B2, 28.2% (n = 11); and B3, 43.6% (n = 17). Most patients were in clinical remission (87.2%; n = 34), with a mean HBI of 2.1 ± 2.2. Twenty-two patients (56.4%) had normal inflammatory markers. IUS (intestinal wall thickening >3 mm and/or Limberg score >1) was abnormal in 61.5% (n = 24) of the cases. Endoscopic remission (Rutgeerts score <i2) in 53.8% (n = 21) of the cases. Compared to endoscopy, IUS (area under the receiver operating characteristic curve [AUROC] = 0.75, p = 0.007) showed a diagnostic accuracy superior to that of inflammatory parameters (AUROC = 0.66, p = 0.083) and clinical parameters (AUROC = 0.64, p = 0.139). IUS showed a moderate concordance with endoscopy (κ = 0.5, p = 0.001), which was higher than that with inflammatory parameters (ĸ = 0.33, p = 0.041) or clinical parameters (ĸ = 0.29, p = 0.01). Conclusions: Ultrasound evaluation of the digestive wall is a noninvasive technique that shows a good diagnostic accuracy and a moderate concordance with endoscopy, being superior to clinical and serological/fecal inflammatory parameters. |
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Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic FindingsPapel da ecografia da parede digestiva na avaliação da recorrência pós-cirúrgica na Doença de Crohn: correlação com os achados endoscópicosIntestinal ultrasoundPostsurgical recurrenceCrohn diseaseEcografia da parede digestivaRecorrência pós-cirúrgicaDoença de CrohnEndoscopy remains the exam of choice in the evaluation of activity in Crohn's disease (CD) after surgery (ACD-AS). However, intestinal ultrasound (IUS) may represent a noninvasive alternative. The objective of this study is to determine the diagnostic accuracy of this modality compared to endoscopy. Material and Methods: This is a crosssectional study, comprising a period of 14 months, carried out in patients with established CD and ileocecal resection due to the disease. IUS (HI-VISION Avius®, Tokyo, Japan) was performed with linear probe B-mode/Doppler prior to ileocolonoscopy. IUS and ileocolonoscopy were performed on the same day by 2 specialists in Gastroenterology dedicated to ultrasound and inflammatory bowel disease, in a doubleblind mode. Collected demographic and clinical data (Harvey- Bradshaw Index [HBI]; remission ≤4), serological/fecal inflammatory parameters (leukocytes [4–10 × 109 cells/L], Creactive protein [≤0.5 mg/dL], and fecal calprotectin [<50 mg/kg]), endoscopy (Rutgeerts score: remission <i2), and ultrasound (intestinal wall thickening [≤3 mm] and digestive wall vascularization using the semiquantitative score of Limberg [absent = 0, sparse = 1, moderate = 2, and marked = 3]). Results: Thirty-nine patients (female: 64.1%, mean age: 43.5 ± 15.3 years) were included. The median post-surgery follow- up was 9 years (IQR 3–12). The Montreal classification was as follows: L1, 61.5% (n = 24); L3, 38.5% (n = 15); B1 and B2, 28.2% (n = 11); and B3, 43.6% (n = 17). Most patients were in clinical remission (87.2%; n = 34), with a mean HBI of 2.1 ± 2.2. Twenty-two patients (56.4%) had normal inflammatory markers. IUS (intestinal wall thickening >3 mm and/or Limberg score >1) was abnormal in 61.5% (n = 24) of the cases. Endoscopic remission (Rutgeerts score <i2) in 53.8% (n = 21) of the cases. Compared to endoscopy, IUS (area under the receiver operating characteristic curve [AUROC] = 0.75, p = 0.007) showed a diagnostic accuracy superior to that of inflammatory parameters (AUROC = 0.66, p = 0.083) and clinical parameters (AUROC = 0.64, p = 0.139). IUS showed a moderate concordance with endoscopy (κ = 0.5, p = 0.001), which was higher than that with inflammatory parameters (ĸ = 0.33, p = 0.041) or clinical parameters (ĸ = 0.29, p = 0.01). Conclusions: Ultrasound evaluation of the digestive wall is a noninvasive technique that shows a good diagnostic accuracy and a moderate concordance with endoscopy, being superior to clinical and serological/fecal inflammatory parameters.Introdução: A endoscopia permanece o exame de eleição na avaliação da atividade da Doença de Crohn (DC) póscirurgia (ADC-PC). No entanto, a ecografia dirigida à parede digestiva (Eco-PD) pode representar uma alternativa não-invasiva. O objetivo do trabalho é determinar a acurácia diagnóstica e concordância desta modalidade comparativamente à endoscopia. Materiais e métodos: Estudo transversal, compreendendo um período de 14 meses, efetuado a doentes com DC estabelecida e resseção ileocecal pela doença. Realizada Eco-PD (HI-VISION Avius®, Tokyo, Japan) com sonda linear em modo-B/ Doppler previamente à ileocolonoscopia. A Eco-PD e ileocolonoscopia foram realizadas no mesmo dia por 2 especialistas dedicados a ecografia e doença inflamatória intestinal, de forma duplamente cega. Recolhidos dados demográficos, clínicos (índice Harvey-Bradshaw [HBI; remissão: ≤4]), parâmetros inflamatórios serológicos/fecais (leucócitos [4 < N < 10 × 109 células/L], proteína C reativa [≤0,5 mg/dL], calprotectina fecal [N <50 mg/kg]), endoscópicos (score Rutgeerts: remissão < i2) e ecográficos (espessamento [N ≤ 3mm] e vascularização da parede digestiva pelo score semi-quantitativo de Limberg [ausente = 0; escassa = 1; moderada = 2; marcada = 3]). Resultados: Incluídos 39 doentes (sexo feminino: 64,1%, idade média: 43,5 ± 15,3 anos). Seguimento mediano pós-cirurgia de 9 anos (IQR 9). Classificação Montreal: L1 61,5% (n = 24), L3 38,5% (n = 15), B1 e B2 28,2% (n = 11) e B3 43,6% (n = 17). A maioria estava em remissão clínica (87,2%; n = 34) com HBI médio de 2,1 ± 2,2. Vinte e dois doentes (56,4%) tinham marcadores inflamatórios dentro de parâmetros normais. A Eco-PD (espessamento parede intestinal >3 mm e/ou Limberg >1) foi anormal em 61,5% (n = 24). Remissão endoscópica (Rutgeerts < i2) em 53,8% (n = 21). Comparativamente à endoscopia, a Eco-PD (AUROC 0,75; p = 0,007) mostrou acuidade diagnóstica superior aos parâmetros inflamatórios (AUROC 0,66; p = 0,083) e clínica (AUROC 0,64; p = 0,139). A ecografia mostrou uma moderada concordância com a endoscopia (ĸ = 0,5; p = 0,001), superior aos parâmetros inflamatórios (ĸ = 0,33, p = 0,041) ou clínica (ĸ = 0,29, p = 0,01). Conclusões: A avaliação ecográfica da parede digestiva é uma técnica não invasiva que mostrou uma boa acuidade diagnóstica e uma concordância moderada com a endoscopia, superior à clínica e parâmetros inflamatórios serológicos/fecais.S. Karger AG2022-05info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articlehttp://hdl.handle.net/10316/104596http://hdl.handle.net/10316/104596https://doi.org/10.1159/000517999eng2341-4545Macedo, Cláudia PatriciaSarmento Costa, MaraGravito-Soares, ElisaGravito-Soares, MartaFerreira, Ana MargaridaPortela, FranciscoFigueiredo, Pedroinfo:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-01-19T21:43:13Zoai:estudogeral.uc.pt:10316/104596Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:21:17.024764Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings Papel da ecografia da parede digestiva na avaliação da recorrência pós-cirúrgica na Doença de Crohn: correlação com os achados endoscópicos |
title |
Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings |
spellingShingle |
Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings Macedo, Cláudia Patricia Intestinal ultrasound Postsurgical recurrence Crohn disease Ecografia da parede digestiva Recorrência pós-cirúrgica Doença de Crohn |
title_short |
Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings |
title_full |
Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings |
title_fullStr |
Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings |
title_full_unstemmed |
Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings |
title_sort |
Role of Intestinal Ultrasound in the Evaluation of Postsurgical Recurrence in Crohn's Disease: Correlation with Endoscopic Findings |
author |
Macedo, Cláudia Patricia |
author_facet |
Macedo, Cláudia Patricia Sarmento Costa, Mara Gravito-Soares, Elisa Gravito-Soares, Marta Ferreira, Ana Margarida Portela, Francisco Figueiredo, Pedro |
author_role |
author |
author2 |
Sarmento Costa, Mara Gravito-Soares, Elisa Gravito-Soares, Marta Ferreira, Ana Margarida Portela, Francisco Figueiredo, Pedro |
author2_role |
author author author author author author |
dc.contributor.author.fl_str_mv |
Macedo, Cláudia Patricia Sarmento Costa, Mara Gravito-Soares, Elisa Gravito-Soares, Marta Ferreira, Ana Margarida Portela, Francisco Figueiredo, Pedro |
dc.subject.por.fl_str_mv |
Intestinal ultrasound Postsurgical recurrence Crohn disease Ecografia da parede digestiva Recorrência pós-cirúrgica Doença de Crohn |
topic |
Intestinal ultrasound Postsurgical recurrence Crohn disease Ecografia da parede digestiva Recorrência pós-cirúrgica Doença de Crohn |
description |
Endoscopy remains the exam of choice in the evaluation of activity in Crohn's disease (CD) after surgery (ACD-AS). However, intestinal ultrasound (IUS) may represent a noninvasive alternative. The objective of this study is to determine the diagnostic accuracy of this modality compared to endoscopy. Material and Methods: This is a crosssectional study, comprising a period of 14 months, carried out in patients with established CD and ileocecal resection due to the disease. IUS (HI-VISION Avius®, Tokyo, Japan) was performed with linear probe B-mode/Doppler prior to ileocolonoscopy. IUS and ileocolonoscopy were performed on the same day by 2 specialists in Gastroenterology dedicated to ultrasound and inflammatory bowel disease, in a doubleblind mode. Collected demographic and clinical data (Harvey- Bradshaw Index [HBI]; remission ≤4), serological/fecal inflammatory parameters (leukocytes [4–10 × 109 cells/L], Creactive protein [≤0.5 mg/dL], and fecal calprotectin [<50 mg/kg]), endoscopy (Rutgeerts score: remission <i2), and ultrasound (intestinal wall thickening [≤3 mm] and digestive wall vascularization using the semiquantitative score of Limberg [absent = 0, sparse = 1, moderate = 2, and marked = 3]). Results: Thirty-nine patients (female: 64.1%, mean age: 43.5 ± 15.3 years) were included. The median post-surgery follow- up was 9 years (IQR 3–12). The Montreal classification was as follows: L1, 61.5% (n = 24); L3, 38.5% (n = 15); B1 and B2, 28.2% (n = 11); and B3, 43.6% (n = 17). Most patients were in clinical remission (87.2%; n = 34), with a mean HBI of 2.1 ± 2.2. Twenty-two patients (56.4%) had normal inflammatory markers. IUS (intestinal wall thickening >3 mm and/or Limberg score >1) was abnormal in 61.5% (n = 24) of the cases. Endoscopic remission (Rutgeerts score <i2) in 53.8% (n = 21) of the cases. Compared to endoscopy, IUS (area under the receiver operating characteristic curve [AUROC] = 0.75, p = 0.007) showed a diagnostic accuracy superior to that of inflammatory parameters (AUROC = 0.66, p = 0.083) and clinical parameters (AUROC = 0.64, p = 0.139). IUS showed a moderate concordance with endoscopy (κ = 0.5, p = 0.001), which was higher than that with inflammatory parameters (ĸ = 0.33, p = 0.041) or clinical parameters (ĸ = 0.29, p = 0.01). Conclusions: Ultrasound evaluation of the digestive wall is a noninvasive technique that shows a good diagnostic accuracy and a moderate concordance with endoscopy, being superior to clinical and serological/fecal inflammatory parameters. |
publishDate |
2022 |
dc.date.none.fl_str_mv |
2022-05 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://hdl.handle.net/10316/104596 http://hdl.handle.net/10316/104596 https://doi.org/10.1159/000517999 |
url |
http://hdl.handle.net/10316/104596 https://doi.org/10.1159/000517999 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
2341-4545 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
S. Karger AG |
publisher.none.fl_str_mv |
S. Karger AG |
dc.source.none.fl_str_mv |
reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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1799134103568646144 |