Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 21, 2017; 23(35): 6482-6490
Published online Sep 21, 2017. doi: 10.3748/wjg.v23.i35.6482
Fecal marker levels as predictors of need for endoscopic balloon dilation in Crohn’s disease patients with anastomotic strictures
Susana Lopes, Patrícia Andrade, Eduardo Rodrigues-Pinto, Joana Afonso, Guilherme Macedo, Fernando Magro
Susana Lopes, Patrícia Andrade, Eduardo Rodrigues-Pinto, Guilherme Macedo, Fernando Magro, Gastroenterology Department, Faculty of Medicine, Hospital de São João, 4200-319 Porto, Portugal
Joana Afonso, Fernando Magro, Department of Pharmacology and Therapeutics, University of Porto, 4200-319 Porto, Portugal
Author contributions: Lopes S and Magro F were responsible for study design; Lopes S and Andrade P were responsible for data collection; Afonso J performed all laboratorial procedures; Rodrigues-Pinto E and Andrade P were responsible for statistical analysis; Lopes S and Andrade P wrote the manuscript; Magro F and Macedo G revised and approved the final manuscript; All the named authors, contributing directly to the work described, have agreed on the respective roles of each author, read the manuscript and approved submission.
Institutional review board statement: The study was approved by the Ethics Committee of Centro Hospitalar São João, Porto, Portugal.
Informed consent statement: All patients gave informed written consent to participate in the study.
Conflict-of-interest statement: The authors of this manuscript have no conflict of interest to declare.
Data sharing statement: There is no additional data available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Guilherme Macedo, PhD, Department of Gastroenterology, Centro Hospitalar São João, Alameda Professor, Hernani Monteiro, 4200-319 Porto, Portugal. guilherme.macedo@hsjoao.min-saude.pt
Telephone: +351-22-5513600 Fax: +351-22-5513601
Received: March 1, 2017
Peer-review started: March 3, 2017
First decision: June 3, 2017
Revised: June 22, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: September 21, 2017
Processing time: 204 Days and 1.9 Hours
Abstract
AIM

To evaluate the accuracy and best cut-off value of fecal calprotectin (FC) and fecal lactoferrin (FL) to predict disease recurrence in asymptomatic patients presenting with anastomotic strictures.

METHODS

This was a longitudinal single tertiary center study based on prospectively collected data (recorded in a clinical database created for this purpose) performed between March 2010 and November 2014. Crohn’s disease (CD) patients with anastomotic stricture who submitted to postoperative endoscopic evaluation were included. Stools were collected on the day before bowel cleaning for FC and FL. Endoscopic balloon dilation (EBD) was performed if the patient presented an anastomotic stricture not traversed by the colonoscope, regardless of patients’ symptoms. Successful dilation was defined as passage of the colonoscope through the dilated stricture into the neotermimal ileum. Postoperative recurrence was defined as a modified Rutgeerts score of ≥ i2b.

RESULTS

In a total of 178 patients who underwent colonoscopy, 58 presented an anastomotic stricture, 86% were asymptomatic, and 48 (54% male; median age of 46.5 years) were successfully dilated. Immediate success rate was 92% and no complications were recorded. FC and FL levels correlated significantly with endoscopic recurrence (P < 0.001) with an optimal cut-off value of 90.85 µg/g (sensitivity of 95.5%, specificity of 69.2%, positive predictive value (PPV) of 72.4%, negative predictive value (NPV) of 94.7% and accuracy of 81%] for FC and of 5.6 µg/g (sensitivity of 77.3%, specificity of 69.2%, PPV of 68%, NPV of 78.4% and accuracy of 72.9%) for FL.

CONCLUSION

Fecal markers are good predictors of CD endoscopic recurrence in patients with asymptomatic anastomotic stricture. FC and FL may guide the need for EBD in this context.

Keywords: Crohn’s disease; Anastomotic strictures; Endoscopic balloon dilation; Fecal markers; Postoperative recurrence

Core tip: This longitudinal study evaluated the accuracy of fecal calprotectin (FC) and fecal lactoferrin (FL) to predict disease recurrence in postoperative Crohn’s disease asymptomatic patients with an anastomotic stricture. FC and FL levels accurately predicted en-doscopic recurrence in the presence of anastomotic stricture and thus may guide the need for endoscopic balloon dilation (EBD) in this context. A normal value of fecal markers can reassure clinicians and be safely used to avoid balloon dilation if we only aim to diagnose recurrence. A high value of fecal markers has a high likelihood of recurrence so EBD should be performed in order to provide adequate endoscopic therapy and adjust or optimize medical therapy.