Observational Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2018; 24(5): 641-650
Published online Feb 7, 2018. doi: 10.3748/wjg.v24.i5.641
Faecal calprotectin and magnetic resonance imaging in detecting Crohn’s disease endoscopic postoperative recurrence
Pierre Baillet, Guillaume Cadiot, Marion Goutte, Felix Goutorbe, Hedia Brixi, Christine Hoeffel, Christophe Allimant, Maud Reymond, Hélène Obritin-Guilhen, Benoit Magnin, Gilles Bommelaer, Bruno Pereira, Constance Hordonneau, Anthony Buisson
Pierre Baillet, Benoit Magnin, Constance Hordonneau, Université Clermont Auvergne, CHU Clermont-Ferrand, Service de radiologie, Clermont-Ferrand 63000, France
Guillaume Cadiot, Hedia Brixi, CHU de Reims, Service d’Hépato-Gastro Entérologie, Reims 51100, France
Marion Goutte, Felix Goutorbe, Christophe Allimant, Maud Reymond, Hélène Obritin-Guilhen, Gilles Bommelaer, Anthony Buisson, Université Clermont Auvergne, Inserm, 3iHP, CHU Clermont-Ferrand, Service d’Hépato-Gastro Entérologie, Clermont-Ferrand 63000, France
Marion Goutte, Gilles Bommelaer, Anthony Buisson, Université Clermont Auvergne, Inserm U1071, M2iSH, USC-INRA 2018, Clermont-Ferrand 63000, France
Felix Goutorbe, CH de Bayonne, Service d’Hépato-Gastro Entérologie, Bayonne 64100, France
Christine Hoeffel, CHU de Reims, Service de radiologie, Reims 51100, France
Bruno Pereira, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand 63000, France
Author contributions: Buisson A designed the study; Baillet P, Cadiot G, Goutte M, Goutorbe F, Brixi H, Hoeffel C, Allimant C, Reymond M, Obritin-Guilhen H, Magnin B, Bommelaer G and Buisson A performed the research; Pereira B performed statistical analysis; Baillet P and Buisson A analyzed the data; Baillet P and Buisson A wrote the paper.
Institutional review board statement: The protocol was approved by the local Ethics Committee (number 2014/CE 42).
Informed consent statement: The study was performed in accordance with the Declaration of Helsinki, Good Clinical Practice and applicable regulatory requirements. Informed consent was obtained from each patient included in the study.
Conflict-of-interest statement: The authors declare no conflict of interest related to this work.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at a_buisson@hotmail.fr.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Anthony Buisson, MD, PhD, Associate Professor, Senior Lecturer, Department of Gastroenterology, University Hospital Estaing, 1 place Lucie et Raymond Aubrac, Clermont-Ferrand 63100, France. a_buisson@hotmail.fr
Telephone: +33-473-750523 Fax: +33-473-750524
Received: December 2, 2017
Peer-review started: December 4, 2017
First decision: January 4, 2018
Revised: January 5, 2018
Accepted: January 15, 2018
Article in press: January 15, 2018
Published online: February 7, 2018
Abstract
AIM

To assess magnetic resonance imaging (MRI) and faecal calprotectin to detect endoscopic postoperative recurrence in patients with Crohn’s disease (CD).

METHODS

From two tertiary centers, all patients with CD who underwent ileocolonic resection were consecutively and prospectively included. All the patients underwent MRI and endoscopy within the first year after surgery or after the restoration of intestinal continuity [median = 6 mo (5.0-9.3)]. The stools were collected the day before the colonoscopy to evaluate faecal calprotectin level. Endoscopic postoperative recurrence (POR) was defined as Rutgeerts’ index ≥ i2b. The MRI was analyzed independently by two radiologists blinded from clinical data.

RESULTS

Apparent diffusion coefficient (ADC) was lower in patients with endoscopic POR compared to those with no recurrence (2.03 ± 0.32 vs 2.27 ± 0.38 × 10-3 mm²/s, P = 0.032). Clermont score (10.4 ± 5.8 vs 7.4 ± 4.5, P = 0.038) and relative contrast enhancement (RCE) (129.4% ± 62.8% vs 76.4% ± 32.6%, P = 0.007) were significantly associated with endoscopic POR contrary to the magnetic resonance index of activity (MaRIA) (7.3 ± 4.5 vs 4.8 ± 3.7; P = 0.15) and MR scoring system (P = 0.056). ADC < 2.35 × 10-3 mm²/s [sensitivity = 0.85, specificity = 0.65, positive predictive value (PPV) = 0.85, negative predictive value (NPV) = 0.65] and RCE > 100% (sensitivity = 0.75, specificity = 0.81, PPV = 0.75, NPV = 0.81) were the best cut-off values to identify endoscopic POR. Clermont score > 6.4 (sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74), MaRIA > 3.76 (sensitivity = 0.61, specificity = 0.82, PPV = 0.73, NPV = 0.74) and a MR scoring system ≥ MR1 (sensitivity = 0.54, specificity = 0.82, PPV = 0.70, and NPV = 0.70) demonstrated interesting performances to detect endoscopic POR. Faecal calprotectin values were significantly higher in patients with endoscopic POR (114 ± 54.5 μg/g vs 354.8 ± 432.5 μg/g; P = 0.0075). Faecal calprotectin > 100 μg/g demonstrated high performances to detect endoscopic POR (sensitivity = 0.67, specificity = 0.93, PPV = 0.89 and NPV = 0.77).

CONCLUSION

Faecal calprotectin and MRI are two reliable tools to detect endoscopic POR in patients with CD.

Keywords: Faecal calprotectin, Magnetic resonance imaging, Postoperative recurrence, Crohn’s disease, Clermont score, Magnetic resonance index of activity

Core tip: Performing a colonoscopy within the first year after surgery is now recommended in the management of postoperative Crohn’s disease (CD) to decrease the risk of symptomatic recurrence. However, endoscopy is felt as a burdensome procedure by the patients highlighting the need for more convenient tools. In our prospective study from two referral centers, we showed that faecal calprotectin measurement and magnetic resonance imaging with Clermont score or magnetic resonance index of activity calculation are two reliable tools to detect early endoscopic postoperative recurrence in CD and could then be an alternative to colonoscopy.