Preoperative Characteristics and Postoperative Behavior of Bowel Wall on Risk of Recurrence After Conservative Surgery in Crohn’s Disease

Crohn’s disease (CD) is a chronic condition with an unpredictable course that is frequently characterized by a high rate of recurrence and in most patients a need for surgical treatment. Approximately 60% to 70% of patients require at least one surgical treatment, 1 often for bowel obstruction. In the past, wide resections have proved to be ineffective in preventing relapses, and repeated resective surgery can lead to malabsorption and short bowel syndrome in many instances. 2–5 During the past decade, strictureplasty and new bowel-sparing techniques have therefore been proposed for the conservative treatment of intestinal strictures. 4,6–9 The early postoperative results show that these techniques are effective and safe in terms of complications and death; further, long-term clinical and surgical recurrence rates are comparable with those observed after conventional resective surgery. 10–12 However, despite these encouraging results, the clinical course of CD and the behavior of the diseased intestinal walls after conservative surgery have so far been little investigated. Ultrasonography has recently been proposed as an accurate means of evaluating bowel walls in patients with CD. 13–18 Several studies have shown that transabdominal ultrasound can detect transmural changes and the degree of thickness of intestinal bowel wall, 19–21 and this technique is as accurate as barium radiology or scintigraphy in assessing the presence, location, and extent of inflammatory bowel disease, 15,18,21 particularly in bowel segments such as the ileum that are not easily to assess by endoscopy. It has also been shown that ultrasound can detect recurrences after “radical” surgical resections 22,23 and the intestinal complications of CD. 24,25 No study has yet evaluated the behavior of the thickness of diseased intestinal wall after conservative surgery in CD, or whether the presurgical ultrasound characteristics and postsurgical behavior of bowel wall thickness (BWT) have prognostic implications on clinical and surgical recurrences. The aims of this study were to evaluate in patients with CD using transabdominal ultrasound the morphologic characteristics of the diseased bowel wall before and after conservative surgery and to assess whether these characteristics and their postoperative behavior are useful prognostic factors for clinical and surgical recurrence after conservative surgery.