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. 2024 Mar 27;16(3):740-750.
doi: 10.4240/wjgs.v16.i3.740.

Pre-operative visceral adipose tissue radiodensity is a potentially novel prognostic biomarker for early endoscopic post-operative recurrence in Crohn's disease

Phillip Gu  1 , Shishir Dube  2 , Norman Gellada  3 , So Yung Choi  4 , Susan Win  3 , Yoo Jin Lee  5 , Shaohong Yang  2 , Talin Haritunians  2 , Gil Y Melmed  2 , Eric A Vasiliauskas  2 , Niru Bonthala  6 , Gaurav Syal  7 , Andres J Yarur  2 , David Ziring  8 , Shervin Rabizadeh  8 , Phillip Fleshner  9 , Cindy Kallman  3 , Suzanne Devkota  2 , Stephan R Targan  2 , Dalin Li  2 , Dermot Pb McGovern  2
Affiliations

Pre-operative visceral adipose tissue radiodensity is a potentially novel prognostic biomarker for early endoscopic post-operative recurrence in Crohn's disease

Phillip Gu et al. World J Gastrointest Surg. .

Abstract

Background: Evidence suggests inflammatory mesenteric fat is involved in post-operative recurrence (POR) of Crohn's disease (CD). However, its prognostic value is uncertain, in part, due to difficulties studying it non-invasively.

Aim: To evaluate the prognostic value of pre-operative radiographic mesenteric parameters for early endoscopic POR (ePOR).

Methods: We conducted a retrospective cohort study of CD subjects ≥ 12 years who underwent ileocecal or small bowel resection between 1/1/2007 to 12/31/2021 with computerized tomography abdomen/pelvis ≤ 6 months pre-operatively and underwent ileocolonoscopy ≤ 15 months post-operatively. Visceral adipose tissue (VAT) volume (cm3), ratio of VAT:subcutaneous adipose tissue (SAT) volume, VAT radiodensity, and ratio of VAT:SAT radiodensity were generated semiautomatically. Mesenteric lymphadenopathy (LAD, largest lymph node > 10 mm) and severe vasa recta (VR) engorgement (diameter of the VR supplying diseased bowel ≥ 2 × VR supplying healthy bowel) were derived manually. The primary outcome was early ePOR (Rutgeert's score ≥ i2 on first endoscopy ≤ 15 months post-operatively) and the secondary outcome was ePOR severity (Rutgeert's score i0-4). Regression analyses were performed adjusting for demographic and disease-related characteristics to calculate adjusted odds ratio (aOR) and 95% confidence interval (CI).

Results: Of the 139 subjects included, 45% of subjects developed early ePOR (n = 63). VAT radiodensity (aOR 0.59, 95%CI: 0.38-0.90) and VAT:SAT radiodensity (aOR 8.54, 95%CI: 1.48-49.28) were associated with early ePOR, whereas, VAT volume (aOR 1.23, 95%CI: 0.78-1.95), VAT:SAT volume (aOR 0.80, 95%CI: 0.53-1.20), severe VR engorgement (aOR 1.53, 95%CI: 0.64-3.66), and mesenteric LAD (aOR 1.59, 95%CI: 0.67-3.79) were not. Similar results were observed for severity of ePOR.

Conclusion: VAT radiodensity is potentially a novel non-invasive prognostic imaging marker to help risk stratify CD patients for POR.

Keywords: Computed tomography; Creeping fat; Crohn’s disease; Mesenteric adipose tissue; Surgery; Visceral adipose tissue.

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Conflict of interest statement

Conflict-of-interest statement: Li D has received consulting fees from Prometheus Biosciences Inc; Syal G has received research support from Pfizer; Yarur AJ has received consulting fees from Bristol Myers Squibb, Arena, Pfizer, Takeda and Landos; Targan SR serves on the scientific advisory board for Seaver Foundation for Austim, and has stock options in Promethus Biosciences Inc; Ziring D is on the speaking bureau for AbbVie, Prometheus Labs, and Regeneron; Rabizadeh S has advised for Prometheus and Janssen; Melmed GY has received consulting fees from Abbvie, Arena Pharmaceuticals, Bristol-Myers Squibb, Boehringer-Ingelheim, Celgene, Dieta, Entasis, Fresenius Kabi, Genentech, Gilead, Janssen, Medtronic, Merck, Oshi, Prometheus Labs, Pfizer, Takeda, Techlab; Fleshner P has received consulting fees from Takeda; McGovern DPB has received consulting fees from Takeda, Prometheus Biosciences Inc, Prometheus Labs; Other authors have no conflicts of interests to disclose.

Figures

Figure 1
Figure 1
Flowchart for inclusion and exclusion criteria. ICR: Ileocecal resection; SBR: Small bowel resection; CSMC: Cedars-Sinai Medical Center; CT: Computerized tomography; MRI: Magnetic resonance imaging.
See this image and copyright information in PMC

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