Early improvement in bowel wall thickness on transperineal ultrasonography predicts treatment success in active ulcerative colitis

Abstract

Summary Background Bowel ultrasonography is a non‐invasive imaging tool that can repeatedly monitor ulcerative colitis (UC) activity. Aim This study aimed to determine whether early transabdominal or transperineal ultrasonography changes can predict subsequent clinical response to induction therapy in patients with UC. Methods This single‐centre prospective study explored ultrasonographic predictors for clinical remission (patient‐reported outcome‐2 ≤ 1 with no rectal bleeding subscore) at week 8 in patients with active UC who underwent induction therapy, in comparison with faecal calprotectin and C‐reactive protein (measured at baseline, week 1 and week 8). Predictive factors were assessed using multivariable regression models and receiver‐operating‐characteristic curve analysis. Results A total of 100 patients were analysed, of which 54 achieved remission at week 8. Baseline biomarker and ultrasonographic‐parameter values were not predictive of remission. Contrastingly, change from baseline to week 1 in rectal bowel wall thickness measured using transperineal ultrasonography was an independent predictor of remission by week 8 (adjusted odds ratio is associated with a 1‐mm decrease: 1.90 [95% confidence interval, 1.22–2.95]). In a subgroup analysis of the patients who did not achieve remission in 1 week, the predictive value of change in rectal bowel wall thickness remained high (AUC = 0.77 [95% confidence interval, 0.61–0.88]). Conclusion Improvement in rectal bowel wall thickness measured using transperineal ultrasonography at week 1 predicts treatment success and potentially facilitates decision making during the early course of induction therapy in UC.

Editorial: the importance of utilising gastrointestinal ultrasound via transperineal approach in ulcerative colitis—an accurate early predictor of response to treatment. Authors' reply

“…We appreciate Dr Ardalan's and Dr Freidman's insightful editorial 1 on our publication, which showed that improvement in rectal bowel wall thickness (ΔrBWT) assessed by transperineal ultrasonography (TPUS) at 1 week post-induction therapy predicts subsequent clinical remission of ulcerative colitis (UC). 2 We agree that the clinical application of our findings may depend on the accuracy of the measurement of rBWT. Although not reported in the manuscript, interobserver variability of ΔrBWT between two independent examiners in this study was preliminarily calculated as 0.74 (95% confidence interval [CI] 0.64-0.83) (intraclass correlation coefficient).…”

“…To view these articles, visit https://doi.org/10.1111/apt.16817 and https://doi. org/10.1111/apt.16868 Shintaro Sagami 1,2 Taku Kobayashi 1 1…”

“…We appreciate Dr Ardalan’s and Dr Freidman’s insightful editorial 1 on our publication, which showed that improvement in rectal bowel wall thickness (ΔrBWT) assessed by transperineal ultrasonography (TPUS) at 1 week post‐induction therapy predicts subsequent clinical remission of ulcerative colitis (UC) 2 …”

“…Although not reported in the manuscript, interobserver variability of ΔrBWT between two independent examiners in this study was preliminarily calculated as 0.74 (95% confidence interval [CI] 0.64–0.83) (intraclass correlation coefficient). In addition, incremental specificity of the magnitude of ΔrBWT in predicting week 8 remission (Table S2 2 ) suggests clinical usefulness when the improvement is clear.…”

Editorial: the importance of utilising gastrointestinal ultrasound via transperineal approach in ulcerative colitis—an accurate early predictor of response to treatment

“…Sagami and colleagues assessed the utility of TAUS, TPUS, CRP and FC at baseline, one and 8 weeks following the commencement of various induction agents (steroids, biologics, tofacitinib or tacrolimus) to predict clinical remission at 8 weeks 8 . The key findings were that improvement in rectal BWT (ΔrBWT), assessed via TPUS and sigmoid BWF(ΔsBWF), assessed via TAUS, at week 1 predicted clinical remission at 8 weeks, with an OR of 1.90 (95% CI 1.22–2.95); p = 0.001 for every 1‐mm decrease in BWT and an OR of 3.16 (95% CI 1.20–8.35); p = 0.030 for every grade decrease of BWF.…”