Intestinal ultrasound to detect postoperative recurrence in patients with Crohn's disease: an international, multidisciplinary, RAND/UCLA appropriateness method study.

We aimed to develop expert-based recommendations for standardising intestinal ultrasound use for the detection and evaluation of postoperative Crohn's disease recurrence.

我们的目标是制定基于专家共识的标准，用于规范肠部超声在检测和评估克罗恩病术后复发中的使用。

Methods

An international, multidisciplinary, modified RAND/University of California Los Angeles appropriateness method was used.

采用了一种国际性的、多学科的、改良的RAND/加州大学洛杉矶分校适宜性方法。

Based on a systematic reviewand meta-analysisof the literature, expert opinion, and panellist feedback, a list of statements related to the use of intestinal ultrasound in this setting was generated.

基于对文献的系统回顾和荟萃分析、专家意见以及小组成员反馈，生成了一组与在本场景下使用肠超声相关的声明列表。

Panellists with expertise in Crohn's disease intestinal ultrasound, surgery, postoperative management, clinical trials, and outcome measures were invited.

邀请了在克罗恩病肠道超声、外科手术、术后管理、临床试验和结果测量方面具有专业知识的专家小组成员。

Panellists rated the appropriateness of each statement on a 9-point Likert scale in two rounds of voting, with statements classified as appropriate, inappropriate, or uncertain based on median panel rating and the presence of disagreement, then met in person to discuss the results and vote on the appropriate and inappropriate statements in a final round of ratification voting.

专家小组成员在两轮投票中使用9点Likert量表对每项声明的适当性进行了评分，根据中位数小组评分和是否存在分歧将声明分类为适当、不适当或不确定，然后亲自会面讨论结果，并在最终的确认投票轮中对适当和不适当的声明进行投票。

Statements ratified by 75% or more of the panellists were incorporated into the final recommendations.

75% 或更多专家小组成员认可的声明被纳入最终建议。

Results

The first online survey was open to the panellists from June 21, 2024, to Aug 6, 2024, and the second survey round was available between Nov 1 and Nov 25, 2024.

第一轮在线调查于 2024 年 6 月 21 日至 8 月 6 日对专家小组成员开放，第二轮调查在 2024 年 11 月 1 日至 11 月 25 日之间进行。

The in-person ratification meeting was held on Feb 21, 2025.

现场确认会议于2025年2月21日举行。

The panel comprised 16 experts (12 [75%] men and four [25%] women) from nine countries (Brazil, Canada, Denmark, Germany, Italy, the Netherlands, Spain, the UK, and the USA) with specialties in gastroenterology (n=10), colorectal surgery (n=4), and radiology (n=2).

该专家小组由来自九个国家（巴西、加拿大、丹麦、德国、意大利、荷兰、西班牙、英国和美国）的16位专家组成，其中男性12名（占75%），女性4名（占25%）。这些专家的专业领域包括胃肠病学（n=10）、结直肠外科（n=4）和放射学（n=2）。

The overall response rate was 100% (all 16 panellists) for the first round of voting and 94% (15 of 16) for the second round of voting, with 12 (75%) of 16 panellists participating in ratification voting.

第一轮投票的总响应率为100%（所有16位专家），第二轮投票的总响应率为94%（15位专家），在确认性投票中，有12位（75%）专家参与。

The first survey contained 116 statements, with 88 (76%) rated as appropriate, two (2%) as inappropriate, and 26 (22%) as uncertain.

第一份调查包含116个陈述，其中88个（76%）被评定为适当，2个（2%）被评定为不适当，26个（22%）被评定为不确定。

Of the 122 statements in the second survey, 97 (80%) were rated appropriate, two (2%) were inappropriate, and 23 (19%) were uncertain. 79 statements were voted on during the ratification meeting and 67 (85%) were ratified.

在第二次调查的122条陈述中，有97条（80%）被评为适当，两条（2%）被评为不适当，23条（19%）被认为不确定。在批准会议上对79条陈述进行了投票，其中67条（85%）被批准。

Recommended anatomical components for sonographic evaluation were the colonic segment immediately distal to the anastomosis, the neoterminal ileum, neoterminal ileal inlet, colonic and ileal blind side of the anastomosis, sonographically visible colonic segments, and the surrounding mesentery.

推荐的超声评估解剖部分包括吻合口远端的结肠段、新末端回肠、新末端回肠入口、吻合口的结肠盲侧和回肠盲侧以及超声可见的结肠段和周围的肠系膜。

Recommended parameters for assessment were bowel wall thickness, bowel wall stratification, bowel wall vascularity; mesenteric inflammatory fat and lymphadenopathy; luminal narrowing; and the presence of complications (abscess, inflammatory mass, fistula or sinus tract, stricture and stricture length, and prestenotic dilation).

评估推荐的参数包括肠壁厚度、肠壁分层、肠壁血流；肠系膜炎症性脂肪和淋巴结病；腔道狭窄；以及并发症的存在（脓肿、炎症性肿块、瘘管或窦道、狭窄及其长度和狭窄前扩张）。

Intestinal ultrasound findings in the neoterminal ileum and the inlet of the neoterminal ileum were considered most likely to reflect clinically meaningful disease activity.

新末端回肠及其入口的肠超声检查结果被认为最有可能反映临床上有意义的疾病活动性。

Waiting at least 4 weeks after surgery to perform intestinal ultrasound was recommended to avoid confounding the interpretation of sonographic findings with immediate postoperative complications or changes associated with surgical healing.

建议在手术后至少等待4周再进行肠超声检查，以避免手术后并发症或与手术愈合相关的改变混淆超声检查结果的解释。

The first assessment is recommended to be performed 3-12 months after surgery.

建议在手术后3-12个月内进行首次评估。

interpretation

These multidisciplinary recommendations aim to standardise the application of intestinal ultrasound for assessing postoperative recurrence of Crohn's disease after surgical bowel ileocolic resection.

这些多学科的建议旨在标准化应用肠超声来评估克罗恩病患者在手术切除回结肠后的术后复发情况。

Future development of a reliable, validated index for Crohn's disease postoperative recurrence is an important next step.

开发一个可靠且经过验证的克罗恩病术后复发指数是未来重要的一步。

funding

Johnson & Johnson Innovative Medicine.

强生创新药物公司。