Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2022, 166(3):297-303 | DOI: 10.5507/bp.2021.050

Predictive value of tissue calprotectin for disease recurrence after ileocecal resection in pediatric Crohn's disease

Kristyna Zarubova^a, Ondrej Fabian^{b, c, d}, Ondrej Hradsky^a, Tereza Lerchova^a, Filip Mikus^d, Vojtech Dotlacil^e, Lucie Pos^e, Richard Skaba^e, Jiri Bronsky^a

^a Gastroenterology and Nutrition Unit, Department of Paediatrics, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, Prague 5, 150 06, Czech Republic

^b Clinical and Transplant Pathology Centre, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague 4, 140 21, Czech Republic

^c Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine, Charles University and Thomayer Hospital, Videnska 800, Prague 4, 140 59, Czech Republic

^d Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, Prague 5, 150 06, Czech Republic

^e Department of Paediatric Surgery, 2nd Faculty of Medicine, Charles University and University Hospital Motol, V Uvalu 84, Prague 5, 150 06, Prague, Czech Republic

Aim: Detection of possible predictive factors of endoscopic recurrence after ileocecal resection in Crohn's disease could be very beneficial for the individual adjustment of postoperative therapy. The aim of this study was to verify, whether immunohistochemical detection of calprotectin in resection margins is useful in diagnostics of endoscopic recurrence.

Methods: In this study we included pediatric patients with Crohn's disease who underwent ileocecal resection, regardless of pre-operative or post-operative therapy (n=48). We collected laboratory, clinical, surgical, endoscopic and histopathological data at the time of surgery and at 6 months after surgery. The immunohistochemical staining of calprotectin antigen was performed on all paraffin blocks from the resection margins.

Results: Out of 48 patients 52% had endoscopic recurrence in the anastomosis (defined by Rutgeerts score) within 6 months after surgery. The number of cells positive for calprotectin in the proximal resection margin was negatively associated with recurrence (P=0.008), as was the elevated level of total calprotectin (from both resection margins). There was no correlation of calprotectin in distal resection margin and endoscopic recurrence. Fecal calprotectin over 100 ug/g (P=0.0005) and high CRP (P<0.001) at 6 months after ileocecal resection and peritonitis (P=0.048) were associated with endoscopic recurrence.

Conclusion: Approximately half of the patients developed endoscopic recurrence within 6 months after ileocecal resection. The predictive value of tissue calprotectin is questionable, as it is negatively associated with endoscopic recurrence. There are other potentially useful predictors, such as CRP and fecal calprotectin at 6 months after resection and the presence of peritonitis.

Keywords: calprotectin, Crohn's disease, pediatric, recurrence, prediction

Received: March 2, 2021; Revised: July 16, 2021; Accepted: July 19, 2021; Prepublished online: August 24, 2021; Published: September 14, 2022  Show citation