Please cite this article in press as: Paparo F, et al. Crohn’s disease recurrence in patients with ileocolic anastomosis: Value of computed tomography enterography with water enema. Eur J Radiol (2013), http://dx.doi.org/10.1016/j.ejrad.2013.04.033 ARTICLE IN PRESS G Model EURR-6359; No. of Pages 7 European Journal of Radiology xxx (2013) xxx–xxx Contents lists available at SciVerse ScienceDirect European Journal of Radiology jo ur nal ho me page: www.elsevier.com/locate/ejrad Crohn’s disease recurrence in patients with ileocolic anastomosis: Value of computed tomography enterography with water enema Francesco Paparo a , Matteo Revelli b , Cristina Puppo b , Lorenzo Bacigalupo a , Isabella Garello a , Alessandro Garlaschi b , Ennio Biscaldi a , Ludovica Rollandi c , Gian Andrea Binda d , Gian Andrea Rollandi a,∗ a Department of Radiology, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa, Italy b School of Radiology, University of Genoa, Via Leon Battista Alberti 4, 16132 Genoa, Italy c School of Medicine, University of Genoa, Via Leon Battista Alberti 4, 16132 Genoa, Italy d Division of General Surgery, E.O. Ospedali Galliera, Mura della Cappuccine 14, 16128 Genoa, Italy a r t i c l e i n f o Article history: Received 24 January 2013 Received in revised form 26 April 2013 Accepted 29 April 2013 Keywords: Crohn’s disease Inflammatory bowel diseases Recurrence Computed tomography Surgical anastomosis a b s t r a c t 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 gastroin- testinal 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. © 2013 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Ileocolic resection with ileocolic anastomosis may be necessary in Crohn’s disease (CD) patients that do not respond to conserva- tive medical treatment. Postoperative recurrence is a feature of CD, which is observed in up to 70% of cases [1]. Several factors have been advocated as predictors of early symptomatic CD ana- stomotic recurrence, in particular the distribution of inflammatory lesions (CD location) prior to surgery, disease behavior (i.e. inflam- matory, stricturing, penetrating [2]), and patient’s smoking status [3]. The type of ileocolic anastomosis (stapled side-to-side vs hand- sewn end-to-end anastomoses) has been proposed as a potential risk factor, but results on this issue are controversial [4–6]. Some authors suggest that wide-lumen stapled end-to-end technique ∗ Corresponding author. Tel.: +39 563 4810; fax: +39 010 57481180. E-mail address: rollandi@galliera.it (G.A. Rollandi). may reduce the risk of obstruction of the anastomosis because of a wider anastomotic lumen [6]. The neoterminal ileum is the most frequent site of CD recurrence, but the prevalence of recurrent inflammatory lesions in other gastrointestinal segments distinct from the ileocolic anastomosis has received little attention. Cur- rently, optical colonoscopy with retrograde ileoscopy represents the gold standard technique for the assessment of anastomotic recurrence after surgery, but the procedure is invasive and carries the risk of colonic perforation. Moreover, anastomotic stenosis can hinder the progression of the endoscope such that a complete eval- uation of the anastomotic site, including the neoterminal ileum, is not possible in up to one-third of patients [7]. To overcome the limitations of endoscopy, different non-invasive radiological techniques have been employed to evaluate the postoperative recurrence of CD, including small bowel enteroclysis and small bowel follow-through [8], small intestine contrast ultrasonography (SICUS) [9], CT-enteroclysis and enterography [10,11] and MR- enteroclysis [12]. CT-enterography with water enema (CTe-WE) 0720-048X/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.ejrad.2013.04.033