Samnani Sunil, Ray Christina M, Gill Priyanka, Stein Levi, Buhler Katherine A, Leong Rupert W, Smith Rebecca L, De Cruz Peter, Kaplan Gilaad G, Seow Cynthia H, Lu Cathy, Guizzetti Leonardo, Hoentjen Frank, Marshall John K, Singh Siddharth, Panaccione Remo, Novak Kerri L, Ma Christopher
Division of Gastroenterology, Faculty of Health Sciences, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
Clin Gastroenterol Hepatol. 2025 Jun 2. doi: 10.1016/j.cgh.2025.03.030.
BACKGROUND & AIMS: Colonoscopy is recommended to monitor for Crohn's disease (CD) recurrence after surgical resection. However, repeated colonoscopy is invasive and resource-intensive. We conducted a systematic review and meta-analysis to evaluate the pooled diagnostic accuracy of noninvasive biomarkers and imaging measures for detecting endoscopic CD recurrence, as compared with colonoscopy.
A systematic review was conducted to January 31, 2024, to identify studies evaluating the diagnostic accuracy of C-reactive protein (CRP), fecal calprotectin, computed tomography and magnetic resonance enterography, or intestinal ultrasound (IUS) compared with colonoscopy for detecting CD recurrence. Estimates of sensitivity, specificity, and positive and negative likelihood ratios were pooled using a random-effects hierarchical summary receiver operating characteristic model.
A total of 17 studies (N = 1080) evaluated inflammatory biomarkers and 20 studies (N = 1053) assessed imaging measures. The pooled sensitivity and specificity of CRP (threshold, 5.0 mg/L) were 0.45 (95% confidence interval [CI], 0.33-0.58) and 0.83 (95% CI, 0.68-0.92), respectively. Fecal calprotectin (threshold, 50 μg/g) was moderately sensitive 0.76 (95% CI, 0.70-0.82) but less specific 0.66 (95% CI, 0.56-0.75). Sensitivity for computed tomography enterography/magnetic resonance enterography and IUS was 0.89 (95% CI, 0.73-0.96) and 0.92 (95% CI, 0.75-0.96); specificity was 0.65 (95% CI, 0.43-0.82) and 0.76 (95% CI, 0.52-0.90), respectively. Using optimized radiographic parameters for IUS, specificity was improved to 0.85 (95% CI, 0.71-0.93).
The high sensitivity of fecal calprotectin (<50 μg/g) and cross-sectional imaging can help reduce the need for invasive and costly colonoscopy monitoring for CD recurrence after surgery. Applying optimal definitions of sonographic recurrence by IUS parameters may further improve specificity for making therapeutic decisions without endoscopy.
结肠镜检查被推荐用于监测克罗恩病（CD）手术切除后的复发情况。然而，反复进行结肠镜检查具有侵入性且资源消耗大。我们进行了一项系统评价和荟萃分析，以评估与结肠镜检查相比，非侵入性生物标志物和影像学检查检测内镜下CD复发的合并诊断准确性。
进行了一项截至2024年1月31日的系统评价，以识别评估C反应蛋白（CRP）、粪便钙卫蛋白、计算机断层扫描和磁共振肠造影或肠道超声（IUS）与结肠镜检查相比检测CD复发的诊断准确性的研究。使用随机效应分层汇总接受者操作特征模型汇总敏感性、特异性以及阳性和阴性似然比的估计值。
共有17项研究（N = 1080）评估了炎症生物标志物，20项研究（N = 1053）评估了影像学检查。CRP（阈值5.0 mg/L）的合并敏感性和特异性分别为0.45（95%置信区间[CI]，0.33 - 0.58）和0.83（95%CI，0.68 - 0.92）。粪便钙卫蛋白（阈值50 μg/g）敏感性中等，为0.76（95%CI，0.70 - 0.82），但特异性较低，为0.66（95%CI，0.56 - 0.75）。计算机断层扫描肠造影/磁共振肠造影和IUS的敏感性分别为0.89（95%CI，0.73 - 0.96）和0.92（95%CI，0.75 - 0.96）；特异性分别为0.65（95%CI，0.43 - 0.82）和0.76（95%CI，0.52 - 0.90）。使用针对IUS优化的放射学参数，特异性提高到0.85（95%CI，0.71 - 0.93）。
粪便钙卫蛋白（<50 μg/g）和横断面成像的高敏感性有助于减少术后CD复发进行侵入性且昂贵的结肠镜检查监测的需求。通过IUS参数应用超声复发的最佳定义可能进一步提高在无需内镜检查情况下做出治疗决策的特异性。
