Validated index still needed as experts issue intestinal ultrasound guidance for postoperative Crohn's disease
Christopher Ma, MD; Siwar Albashir, MBBS; Mariangela Allocca, MD; Anthony de Buck van Overstraeten, MD; Paulo G Kotze, MD; Cathy Lu, MD; et al.
May 20, 2026
- The Lancet Gastroenterology & Hepatology
- The Lancet Gastroenterology & Hepatology, Volume 11, Issue 7, Pages 602–615
- 10.1016/S2468-1253(26)00082-8
Evidence before this study
Intestinal ultrasound is increasingly used as a non-invasive method to assess Crohn's disease, and this technique has been shown to accurately and reliably identify parameters related to disease activity, such as bowel wall thickening, loss of bowel wall stratification, and hyperaemia on colour doppler imaging. No studies have reported on the standardisation of parameters to define postoperative recurrence of Crohn's disease using intestinal ultrasound. Postoperative endoscopic recurrence occurs in most patients after surgery and current care frameworks that depend on ileocolonoscopy are invasive and costly. Intestinal ultrasound might offer patients with Crohn's disease an alternative, less invasive, point-of-care method for disease monitoring postoperatively. A systematic review and meta-analysis by Samnani and colleagues was used to inform statements for this study. MEDLINE, Embase, and secondary screening of article references were searched without language restrictions from database inception to Jan 31, 2024, using search terms capturing Crohn's disease, surgery, and postoperative recurrence, to identify studies reporting on the definitions of recurrence and diagnostic accuracy of intestinal ultrasound and other non-invasive modalities for detecting Crohn's disease recurrence after surgery, compared with the gold standard of endoscopic recurrence defined by a Rutgeerts score of at least i2 (or i2b in studies using the modified Rutgeerts score). Most studies were at low risk for bias, and 29 different definitions of sonographic recurrence were considered. Intestinal ultrasound had a pooled sensitivity of 0·89 (95% CI 0·75–0·96) and specificity of 0·76 (0·52–0·90) for detecting recurrence; using varying best performing definitions of recurrence, sensitivity could be improved to 0·93 (0·80–0·98) and specificity to 0·85 (0·71–0·93).
Added value of this study
To facilitate standardisation of a non-invasive method of monitoring patients with Crohn's disease, an international, multidisciplinary expert panel (including gastroenterologists, colorectal surgeons, radiologists, and methodologists) provided recommendations for the appropriate use of intestinal ultrasound to assess postoperative recurrence of Crohn's disease after surgical bowel resection, for use in clinical care and research settings.
Implications of all the available evidence
To our knowledge, this study provides the first set of internationally guided recommendations for using intestinal ultrasound as a non-invasive method to assess postoperative recurrence of Crohn's disease. These recommendations have been developed to provide practical guidance to facilitate standardisation of the use of intestinal ultrasound to monitor patients in this setting. An important next step is to develop a reliable, validated index for postoperative recurrence of Crohn's disease. Use of intestinal ultrasound, which is less invasive and costly than endoscopy, is a high research priority to possibly improve how patients with Crohn's disease are monitored.
