Variation in fecal calprotectin (Fcal) levels in the 3 months following ileocolonic resection is an accurate predictor of early endoscopic postoperative recurrence (POR) in patients with Crohn’s disease (CD), according to results of a multicenter, prospective study published Digestive and Liver Disease.
Predicting endoscopic POR could aid in selecting patients with CD who would benefit from aggressive disease management strategies. However, risk factors for POR remain unknown. Researchers evaluated how serial Fcal monitoring in the 3 months following ileocolonic resection could aid in predicting CD endoscopic POR at 6 months after the procedure.
Researchers consecutively enrolled patients with CD who underwent ileocolonic resection with restoration of bowel continuity from November 2014 to September 2017. Fcal levels were measured using stool samples collected at baseline, 1 month (M1), and 3 months (M3) after the procedure. Samples were collected 1 day prior to endoscopy to reduce intra-individual variation, and immediately stored at 4°C. Ileocolonoscopy was performed at month 6 (M6) after restoration of bowel continuity. Endoscopic POR was defined as Rutgeerts index ≥ i2b.
Overall, 48 patients were included (mean age at inclusion, 35.3; female, 60.4%). Of these, 18 (36%) presented with endoscopic POR (Rutgeerts score ≥ i2b) 6 months after surgery. The researchers observed no significant differences between patients with and without early endoscopic POR (M6), respectively, in the level: of Fcal at baseline (100 vs 166 µg/g; P =.15); M1 (93 vs 100 µg/g; P =.44); and M3 (100 vs. 99 µg/g; P =.28). Fcal kinetics in the first 3 months after surgery differed significantly between patients with and without POR at M6 (P =.021). The relative variation between Fcal levels at baseline and M3 was significantly higher in patients with endoscopic POR compared with those without (P =.01). A relative variation between Fcal levels at baseline and M3 greater than 10% was most effective in predicting endoscopic POR at M6 (area under curve [AUC], 0.73; sensitivity, 64.7%; specificity, 87.5%; negative predictive value, 77.8%; positive predictive value, 78.6%).
Limitations of the study included the lack of central testing of Fcal and sample size calculations.
The authors concluded that their findings “advocate for the widespread use of serial Fcal monitoring in the early postoperative period. However, additional data from independent cohorts are warranted to confirm our results.”
Boube M, Laharie D, Nancey S, Hebuterne X, Fumery M, Pariente B, et al. Variation of faecal calprotectin level within the first three months after bowel resection is predictive of endoscopic postoperative recurrence in Crohn’s disease (published online May 20, 2020). Dig Liver Dis. doi.org/10.1016/j.dld.2020.03.020