Intraoperative Ultrasonography in Patients Undergoing Surgery for Crohn's Disease. Prospective Evaluation of an Innovative Approach to Optimize Staging and Treatment Planning

Percutaneous ultrasonography (perc-US) and magnetic resonance enterography (e-MR) are the present standards for staging patients with Crohn's disease (CD). However, intraoperative data still have some discrepancies with preoperative ones. The contribution of intraoperative ultrasonography (IOUS) has never been evaluated. Sixty-five consecutive patients scheduled for ileal/colonic resection for CD between 2010 and 2014 were prospectively enrolled. All patients had perc-US, e-MR and IOUS. Data from different imaging modalities were compared. The reference standard was the final pathology. Surgery was scheduled because of intestinal obstruction (n = 31 patients), inflammatory mass (n = 21), fistula (n = 10), or abdominal pain/sepsis (n = 3). Fourteen (21.5%) patients had a major discrepancy between preoperative and intraoperative data that required a modification of the surgical planning (five additional ileal lesions, three unknown ileo-sigmoid fistulas, and six not confirmed CD sites). IOUS correctly staged CD in all but one patients (missed ileo-colonic fistula). Pathology data differed from Perc-US data in 13 (20%) patients, from e-MR data in 14 (21.5%), and from IOUS data in one (1.5%). The sensitivity of Perc-US, e-MR and IOUS was: for the identification of CD sites 84.2%, 86.1%, and 100%; for the identification of stenoses 86.8%, 86.8%, and 100%; for the identification of fistulas 75.0%, 81.3%, and 93.8%, respectively. IOUS contributed to the surgical planning in 8 (12.3%) patients. IOUS is a safe, feasible and easy-to-perform procedure that optimizes staging of CD and, in some patients, helps to better define the treatment strategy. It could be helpful to face complex disease presentations on the basis of objective and reproducible data.