Accuracy, advantages, and drawbacks of intestinal ultrasound, magnetic resonance imaging, and capsule endoscopy for the diagnosis of postoperative recurrence [POR]
| Procedures . | Diagnostic accuracy . | Definition of POR . | Advantages . | Drawbacks . |
|---|---|---|---|---|
| Intestinal ultrasound | Pooled sensitivity 82% and pooled specificity 88%15 | Bowel wall thickness >3 mm predicts Rutgeerts score ≥i1.15 Bowel wall thickness ≥5.5 mm predicts severe endoscopic recurrence [Rutgeerts score ≥i3]15 | Non-invasive, no specific preparation or contrast media, patient-friendly, cheap, point-of-care ultrasound. Predictive of clinical and surgical recurrence.66–68 Bowel wall thickness ≥5.5 mm has a specificity of 97.7% for severe endoscopic recurrence [Rutgeerts score ≥i3]15 | Inability to obtain tissue samples. Lower sensitivity for mild endoscopic recurrence [Rutgeerts score i1-i2]71,72 |
| Magnetic resonance imaging | Pooled sensitivity 97% and pooled specificity 84%42 | Magnetic resonance enteroclysis score correlates with the Rutgeerts score [kappa 0.78].61 Monitor index ≥1 has a sensitivity of 79% and a specificity of 55% for detecting a Rutgeerts score ≥i216 | Enteroclysis score is predictive of clinical recurrence.62 Monitor index is a validated score16 | Expensive, not directly available, oral and intravenous contrast media, time consuming. Non-feasible in claustrophobics, in those who cannot hold their breath or lie still. In addition, it cannot be performed on patients with vascular clips, non-conditional cardiac pacemakers or neurostimulator devices, or metal structures such as prostheses, screws, heart valves. Inability to obtain tissue samples |
| Capsule endoscopy | Pooled sensitivity 100%, pooled specificity 69%42 | Rutgeerts score. Lewis score40 in three studies without colonoscopy as reference standard43–45 | Visualise lesions in proximal small bowel. Sensitive in early endoscopic recurrence17,43–45 | Patency system, oral preparation. Difficulty swallowing capsules. Capsule retention [2%]. Time consuming. Inability to obtain tissue samples |
| Procedures . | Diagnostic accuracy . | Definition of POR . | Advantages . | Drawbacks . |
|---|---|---|---|---|
| Intestinal ultrasound | Pooled sensitivity 82% and pooled specificity 88%15 | Bowel wall thickness >3 mm predicts Rutgeerts score ≥i1.15 Bowel wall thickness ≥5.5 mm predicts severe endoscopic recurrence [Rutgeerts score ≥i3]15 | Non-invasive, no specific preparation or contrast media, patient-friendly, cheap, point-of-care ultrasound. Predictive of clinical and surgical recurrence.66–68 Bowel wall thickness ≥5.5 mm has a specificity of 97.7% for severe endoscopic recurrence [Rutgeerts score ≥i3]15 | Inability to obtain tissue samples. Lower sensitivity for mild endoscopic recurrence [Rutgeerts score i1-i2]71,72 |
| Magnetic resonance imaging | Pooled sensitivity 97% and pooled specificity 84%42 | Magnetic resonance enteroclysis score correlates with the Rutgeerts score [kappa 0.78].61 Monitor index ≥1 has a sensitivity of 79% and a specificity of 55% for detecting a Rutgeerts score ≥i216 | Enteroclysis score is predictive of clinical recurrence.62 Monitor index is a validated score16 | Expensive, not directly available, oral and intravenous contrast media, time consuming. Non-feasible in claustrophobics, in those who cannot hold their breath or lie still. In addition, it cannot be performed on patients with vascular clips, non-conditional cardiac pacemakers or neurostimulator devices, or metal structures such as prostheses, screws, heart valves. Inability to obtain tissue samples |
| Capsule endoscopy | Pooled sensitivity 100%, pooled specificity 69%42 | Rutgeerts score. Lewis score40 in three studies without colonoscopy as reference standard43–45 | Visualise lesions in proximal small bowel. Sensitive in early endoscopic recurrence17,43–45 | Patency system, oral preparation. Difficulty swallowing capsules. Capsule retention [2%]. Time consuming. Inability to obtain tissue samples |
Accuracy, advantages, and drawbacks of intestinal ultrasound, magnetic resonance imaging, and capsule endoscopy for the diagnosis of postoperative recurrence [POR]
| Procedures . | Diagnostic accuracy . | Definition of POR . | Advantages . | Drawbacks . |
|---|---|---|---|---|
| Intestinal ultrasound | Pooled sensitivity 82% and pooled specificity 88%15 | Bowel wall thickness >3 mm predicts Rutgeerts score ≥i1.15 Bowel wall thickness ≥5.5 mm predicts severe endoscopic recurrence [Rutgeerts score ≥i3]15 | Non-invasive, no specific preparation or contrast media, patient-friendly, cheap, point-of-care ultrasound. Predictive of clinical and surgical recurrence.66–68 Bowel wall thickness ≥5.5 mm has a specificity of 97.7% for severe endoscopic recurrence [Rutgeerts score ≥i3]15 | Inability to obtain tissue samples. Lower sensitivity for mild endoscopic recurrence [Rutgeerts score i1-i2]71,72 |
| Magnetic resonance imaging | Pooled sensitivity 97% and pooled specificity 84%42 | Magnetic resonance enteroclysis score correlates with the Rutgeerts score [kappa 0.78].61 Monitor index ≥1 has a sensitivity of 79% and a specificity of 55% for detecting a Rutgeerts score ≥i216 | Enteroclysis score is predictive of clinical recurrence.62 Monitor index is a validated score16 | Expensive, not directly available, oral and intravenous contrast media, time consuming. Non-feasible in claustrophobics, in those who cannot hold their breath or lie still. In addition, it cannot be performed on patients with vascular clips, non-conditional cardiac pacemakers or neurostimulator devices, or metal structures such as prostheses, screws, heart valves. Inability to obtain tissue samples |
| Capsule endoscopy | Pooled sensitivity 100%, pooled specificity 69%42 | Rutgeerts score. Lewis score40 in three studies without colonoscopy as reference standard43–45 | Visualise lesions in proximal small bowel. Sensitive in early endoscopic recurrence17,43–45 | Patency system, oral preparation. Difficulty swallowing capsules. Capsule retention [2%]. Time consuming. Inability to obtain tissue samples |
| Procedures . | Diagnostic accuracy . | Definition of POR . | Advantages . | Drawbacks . |
|---|---|---|---|---|
| Intestinal ultrasound | Pooled sensitivity 82% and pooled specificity 88%15 | Bowel wall thickness >3 mm predicts Rutgeerts score ≥i1.15 Bowel wall thickness ≥5.5 mm predicts severe endoscopic recurrence [Rutgeerts score ≥i3]15 | Non-invasive, no specific preparation or contrast media, patient-friendly, cheap, point-of-care ultrasound. Predictive of clinical and surgical recurrence.66–68 Bowel wall thickness ≥5.5 mm has a specificity of 97.7% for severe endoscopic recurrence [Rutgeerts score ≥i3]15 | Inability to obtain tissue samples. Lower sensitivity for mild endoscopic recurrence [Rutgeerts score i1-i2]71,72 |
| Magnetic resonance imaging | Pooled sensitivity 97% and pooled specificity 84%42 | Magnetic resonance enteroclysis score correlates with the Rutgeerts score [kappa 0.78].61 Monitor index ≥1 has a sensitivity of 79% and a specificity of 55% for detecting a Rutgeerts score ≥i216 | Enteroclysis score is predictive of clinical recurrence.62 Monitor index is a validated score16 | Expensive, not directly available, oral and intravenous contrast media, time consuming. Non-feasible in claustrophobics, in those who cannot hold their breath or lie still. In addition, it cannot be performed on patients with vascular clips, non-conditional cardiac pacemakers or neurostimulator devices, or metal structures such as prostheses, screws, heart valves. Inability to obtain tissue samples |
| Capsule endoscopy | Pooled sensitivity 100%, pooled specificity 69%42 | Rutgeerts score. Lewis score40 in three studies without colonoscopy as reference standard43–45 | Visualise lesions in proximal small bowel. Sensitive in early endoscopic recurrence17,43–45 | Patency system, oral preparation. Difficulty swallowing capsules. Capsule retention [2%]. Time consuming. Inability to obtain tissue samples |
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