Purpose of Technology: Crohn disease (CD) patients require frequent monitoring after intestinal resection due to a high likelihood of postoperative recurrence. The reference standard for assessing endoscopic recurrence after ileocolonic resection is ileocolonoscopy; however, this technique is invasive, time consuming, expensive, and carries a risk of complications. Calprotectin is a specific, neutrophil-derived, calcium-binding protein that can be measured in small stool samples and is used as a marker of intestinal inflammation. Fecal calprotectin (FC) testing is a noninvasive approach for monitoring postoperative recurrence.
Rationale: To avoid the inconvenience and discomfort of repeated ileocolonoscopies, researchers have been investigating noninvasive tests, such as the FC assay, for the assessment of postoperative endoscopic recurrence (PER) of CD. FC testing may provide a noninvasive, cost-effective alternative to ileocolonoscopy to predict and monitor PER of CD.
Controversy: While FC testing presents a noninvasive approach for assessment and monitoring of PER, it has several potential disadvantages, including diminished value in patients with CD restricted to the small bowel; imperfect correlation with transmural inflammation; and elevation of levels due to infectious enterocolitis, colorectal cancer, or use of nonsteroidal anti-inflammatory drugs, potentially leading to false-positive FC results. Moreover, an optimal FC cutoff value to distinguish endoscopic recurrence in the postoperative setting has yet to be established.
Relevant Questions:
- What is the clinical validity of the FC assay to predict and monitor PER of CD?
- What is the clinical utility of the FC assay to predict and monitor PER of CD?
- Is FC testing safe for use in patients who may develop PER of CD?
- Have definitive patient selection criteria been established for use of the FC assay to predict and monitor PER of CD?
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