Crohn's disease recurrence in patients with ileocolic anastomosis: Value of computed tomography enterography with water enema

Objectives: the main objective of the present work was to determine the diagnostic value of CT-enterography with water enema (CTe-WE) in the assessment of the ileocolic anastomosis in patients with Crohn's disease (CD). The prevalence of synchronous inflammatory lesions (SILs) involving gastrointestinal segments distinct from the anastomosis was also determined. Further, the association between the type of ileocolic anastomosis and the behavior (i.e. inflammatory, stricturing, penetrating) of CD recurrence was evaluated. Methods: 51 patients were retrospectively included (26 [51%] male and 25 [49%] female; mean age: 52.88 years ± 13.35). Ileocolic anastomoses were: 18 (35.3%) stapled side-to-side, 17 (33.3%) end-to-side, and 16 (31.4%) end-to-end. CTe-WEs were reviewed in consensus by two gastrointestinal radiologists. Endoscopy and medical records were used as reference standards. Results: CTe-WE yielded 95.35% sensitivity (CI 95%: 84.19–99.43%), 75.00% specificity (CI 95%: 34.91–96.81%), and 92.15% diagnostic accuracy (CI 95%: 81.31–98.02%). Anastomotic recurrence was found in 41/51 (80.4%) patients, including 30/41 (73.2%) cases of isolated anastomotic recurrence, and 11/41 (26.8%) cases of anastomotic recurrence with a SIL. A significant lower prevalence of stricturing recurrence was observed in patients with stapled side-to-side anastomoses (p = 0.033). Conclusions: CTe-WE provides a good distension of both sides of ileocolic anastomoses allowing the detection of SILs