The role of calprotectin in predicting endoscopic post-surgical recurrence in asymptomatic Crohn’s disease: a comparison with ultrasound

A. Orlando, I. Modesto, F. Castiglione*, L. Scala, D. Scimeca, A. Rispo*, S. Teresi**, F. Mocciaro, V. Criscuoli, C. Marrone, P. Platania#, T. De Falco*, S. Maisano, N. Nicoli#, M. Cottone

Department of Internal Medicine, “V. Cervello” Hospital – Palermo (Italy) *Department of Gastroenterology, Federico II University – Naples (Italy) **Clinical Pathology laboratory, “G. Di Cristina” Hospital – Palermo (Italy) #Department of General Surgery 1th, “V. Cervello” Hospital – Palermo (Italy)

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• Gastroenterology

Background and Objectives: Faecal calprotectin is predictive of clinical relapse in inflammatory bowel disease and ultrasound is sensitive in detecting its post-surgical recurrence. However, no data regarding the role of calprotectin in predicting post-surgical recurrence in asymptomatic Crohn’s disease are available.
The aim of this study was to prospectively evaluate the role of calprotectin as a predictive marker for one year post-surgical endoscopic recurrence in comparison with ultrasound in patients with asymptomatic Crohn’s disease.

Material and Methods: We consecutively enlisted 50 patients who had undergone a resection for Crohn’s disease. Faecal calprotectin was analysed and ultrasound were performed at the third month, and a colonoscopy after one year. The sensitivity and specificity of these two techniques were evaluated using endoscopic findings as a golden standard. A Receiver Operator Curve (ROC) curve was plotted, in order to identify the best-cut off value for calprotectin.

Results: 39 out of 50 patients were evaluated by performing a colonoscopy after one year; 19 patients had an endoscopic recurrence after one year. Calprotectin sensitivity and specificity were calculated for 5 different cut-off values; the best cut-off value for calprotectin sensitivity (63%) and specificity (75%) was > 200 mg/L. The US sensitivity and specificity at the third month were 26% and 90% respectively.

Conclusions: When performed three months after surgery ultrasound is more specific than calprotectin in predicting endoscopic recurrence. Faecal calprotectin at a dosage > 200 mg/L seems to have a better sensitivity than ultrasound. Values of calprotectin > 200 mg can be an indication to colonoscopy in the group of patients with negative ultrasound in order to detect early recurrence.

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