Combined Ultrasound and Calprotectin at 3 Months Predict Postoperative Recurrence in Crohn’s Disease
A combination of intestinal ultrasound (IUS) and fecal calprotectin (FC) measured 3 months after ileocecal resection may identify patients at risk for early postoperative recurrence of Crohn’s disease (CD), according to a multicenter prospective study.
The study included 113 patients with CD undergoing ileocecal resection across 7 European centers. All participants underwent IUS and FC testing at 3 months and ileocolonoscopy at 6 months, with endoscopic recurrence defined as a modified Rutgeerts score of at least i2b. Nearly half of patients (44%) developed endoscopic recurrence at 6 months.
At 3 months, both bowel wall thickness (BWT) in the neoterminal ileum and FC levels were significantly higher in patients who later developed recurrence. Median BWT was 1.9 mm in those with recurrence versus 1.4 mm in those without, while FC levels were 190 mg/kg versus 98 mg/kg, respectively.
Threshold analysis showed that BWT of at least 2.0 mm and FC of at least 192 mg/kg were independently associated with recurrence, with odds ratios of 6.6 and 3.5, respectively. When combined, these markers significantly increased predictive strength, with an odds ratio of 11.8 and high specificity (96%).
The authors reported that “the combination of IUS and FC at 3 months after ICR predicts endoscopic recurrence,” and noted that these findings “support a paradigm shift toward non-invasive, risk-stratified postoperative monitoring.”
While sensitivity was modest, the high specificity and positive predictive value suggest that patients meeting both thresholds are at high risk for early recurrence and may benefit from closer monitoring or treatment adjustment before 6-month colonoscopy.
Reference
Pruijt M, Janssen R, De Voogd F, et al. Early intestinal ultrasound and fecal calprotectin predict endoscopic recurrence after ileocecal resection in Crohn’s disease: the INSIGHT study. Presented at: Digestive Disease Week; May 2–5, 2026; Chicago, Illinois.
