Abstract Background Postoperative recurrence (POR) of Crohn’s disease (CD) is frequent and may remain asymptomatic. Ileocolonoscopy is the diagnostic gold standard, but its invasiveness and limited availability in some areas hinder repeated use. Intestinal ultrasound (IUS) has emerged as a non-invasive alternative, yet diverse modalities and criteria exist. This systematic review and meta-analysis aimed to assess the diagnostic accuracy of IUS in detecting POR in CD. Methods A systematic search was conducted in PubMed, Embase, Scopus, and Web of Science (up to April 2024), identifying prospective and retrospective studies comparing IUS with ileocolonoscopy. Two reviewers independently screened studies, extracted data, and assessed quality using QUADAS-2. Pooled sensitivity, specificity, likelihood ratios (LR⁺/LR⁻), and diagnostic odds ratios (OR) were calculated under a random-effects model (DerSimonian–Laird). Heterogeneity was evaluated with the I² statistic. A hierarchical summary receiver-operating characteristic (HSROC) curve was constructed. Results Twelve studies were included. The pooled sensitivity for detecting POR through IUS was 0.90 (95% CI: 0.83–0.94) and specificity 0.88 (95% CI: 0.75–0.95), with low-to-moderate heterogeneity (I² = 31.4% and 20.2%, respectively). The pooled positive LR⁺ was 7.36 (95% CI: 3.37–17.87) and the negative LR⁻ 0.12 (95% CI: 0.07–0.20), yielding a diagnostic odds ratio (OR) of 66.12 (95% CI: 24.66–177.32). The HSROC curve demonstrated a summary point with sensitivity of approximately 0.90 and specificity of 0.88, with an area under the curve (AUC) of 0.78. In subgroup analyses, contrast-enhanced modalities (SICUS/CEUS) showed significantly higher sensitivity (93%, 95% CI: 85–96%) than conventional ultrasound (81%, 95% CI: 73–88%) (χ² = 5.06, p = 0.02), while specificities were comparable (88% vs 83%, p = 0.56). Heterogeneity was markedly lower in the contrast-enhanced subgroup (I² = 21.1%) than in the conventional group (I² = 82.8%). When comparing composite IUS scores versus the use of bowel wall thickness alone, studies using multiparametric criteria that integrated bowel wall thickness, vascularity, and enhancement achieved higher sensitivity (95%, 95% CI: 87–98% vs 84%, 95% CI: 77–90%; p = 0.04) and comparable specificity (87% vs 89%, p = 0.71). Conclusion IUS, particularly in its contrast-enhanced forms and when using structured scoring systems, demonstrated good diagnostic performance for detecting postoperative recurrence in CD. Its implementation could optimize clinical follow-up, reduce the need for endoscopic procedures, and support early therapeutic decision-making Conflict of interest: Parra Izquierdo, Leidy Viviana: None Dr. Frías-Ordoñez, Juan: No conflict of interest Eggermont, Elisabeth: I have no conflicts of interest. Verstockt, Bram: Research support from AbbVie, Biora Therapeutics, Celltrion, Landos, Pfizer, Sanofi, Sossei Heptares/Nxera and Takeda. Speaker’s fees from Abbvie, Agomab, Alfasigma, Biogen, Bristol Myers Squibb, Celltrion, Eli Lily, Falk, Ferring, Galapagos, Materia Prima, Johnson and Johnson, Pfizer, Sandoz, Takeda, Tillots Pharma, Truvion and Viatris. Consultancy fees from Abbvie, Alfasigma, Alimentiv, Anaptys Bio, Applied Strategic, Astrazeneca, Atheneum, BenevolentAI, Biora Therapeutics, Boxer Capital, Bristol Myers Squibb, Domain Therapeutics, Eli Lily, Galapagos, Guidepont, Landos, Merck, Mirador Therapeutics, Mylan, Nxera, Inotrem, Ipsos, Johnson and Johnson, Pfizer, Sandoz, Sanofi, Santa Ana Bio, Sapphire Therapeutics, Sosei Heptares, Takeda, Tillots Pharma and Viatris. Stock options Vagustim and Thethis Pharma.
Izquierdo et al. (Thu,) studied this question.
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