Background: There are currently no guidelines on the need to assess disease activity before stoma reversal in Crohn's disease (CD). We sought to determine the value of cross-sectional imaging for detecting active CD (i.e. the recurrence or persistence of lesions present after earlier surgery) before stoma reversal.
Methods: 38 CD patients underwent cross-sectional imaging before stoma reversal. CD activity was blindly evaluated by an independent radiologist. Postoperative outcomes were recorded.
Results: Before stoma reversal, cross-sectional imaging identified active CD in 20 of the 38 study participants (52.6%). CD recurrence was identified upstream of the stoma in 11 of the 38 patients (28.9%), including two with persistent lesions and one with divertive lesions downstream of the stoma. Five of the 38 patients (13.2%) had persistent lesions only (upstream only: n=1; downstream only: n=3; up- and downstream: n=1). Four of the 38 patients (10.5%) had divertive lesions only. In 9 out of 10 tested patients, radiologic and endoscopic assessments gave concordant findings with regard to CD recurrence before stoma reversal. Stoma reversal was delayed in half of the patients with active CD and in none of the patients without active CD. Before stoma reversal, tumor necrosis factor alpha antagonists or immunosuppressants were initiated in 45% of the patients with active CD and 5.6% of the patients without active CD. In the year following stoma reversal, the recurrence rate (in a radiologic assessment) was higher in patients with active CD than in patients without active CD (75.0% vs. 30.8%, respectively; p=0.04).
Conclusions: Cross-sectional imaging revealed postoperative recurrence in about a quarter of patients before stoma reversal; this finding may influence the postoperative treatment strategy and outcomes.