Doppler Activity and Ultrasonographic Detection of Intra-Abdominal Fistulas Are Predictors of Surgery in Crohn’s Disease

Abstract

<b><i>Bakground and Aim:</i></b> Predictors of the need for surgery in sticturing Crohn’s disease (SCD) are lacking. Bowel ultrasound (US) is a harmless, noninvasive, and inexpensive diagnostic procedure that has proven to be a valuable tool in the management of Crohn’s disease (CD). Our aim was to identify ultrasonographic findings in SCD that may associate with a higher risk of surgery, allowing us to make early choices regarding treatment election in this specific group of patients. <b><i>Materials and Methods:</i></b> This was a retrospective, case-control study. Twenty-four patients diagnosed with SCD between 2013 and 2017 with a past history of stricture-related surgery were included and then matched with 46 non-operated controls. Prior US from patients in both groups were analyzed. US features considered for analysis were as follows: bowel wall thickness, degree of parietal vascularization (measured by Doppler activity), prestenotic dilation, involvement of mesenteric fat, and newly detected concomitant fistulas or abscess. <b><i>Results:</i></b> Doppler activity (<i>p</i> &#x3c; 0.001), enteroenteric fistulas (<i>p</i> = 0.04), enteromesenteric fistulas (<i>p</i> = 0.003), and associated abscess (<i>p</i> = 0.004) were significantly associated with the need for surgery in the short-term period. Multivariate analysis showed strong association of these features with the risk of surgery but failed to reach statistical significance. <b><i>Conclusion:</i></b> US features may potentially be used as point-of-care tools to aid clinicians in the assessment of the surgical risk in patients with SCD.