Transperineal ultrasound predicts endoscopic and histological healing in ulcerative colitis

Abstract

Background:Transabdominal ultrasound is useful to assess inflammation in patients with ulcerative colitis (UC); however, the assessment of the rectum is challenging and a barrier for its widespread use. Aim:To evaluate if transperineal ultrasound is useful for predicting endoscopic and histological findings of the rectum in UC.Methods: Fifty-three consecutive adults with UC who required colonoscopy were included and transperineal ultrasound was performed in combination with transabdominal ultrasound within a week before or after colonoscopy with rectal biopsy.Mayo endoscopic subscore (MES) ≤1 was defined as endoscopic healing and Geboes score <2.1, Robarts histopathology index ≤6, and Nancy index ≤1 were defined as histological healing. Limberg score and bowel wall thickness were recorded with transperineal ultrasound. Faecal calprotectin was also measured. Results: Excellent correlation was confirmed between colonoscopy and transabdominal ultrasound in all segments except for the rectum. Rectal bowel wall thickness and Limberg score in transperineal ultrasound well correlated with rectal MES and histological indices. Bowel wall thickness ≤4 mm predicted endoscopic (Area under the curve [AUC] = 0.90) and histological (AUC = 0.87-0.89) healing. In multivariable logistic regression analysis, only bowel wall thickness in transperineal ultrasound was a significant independent predictor for rectal endoscopic and histologic healing (P < 0.05) and the predictability was better than faecal calprotectin. Conclusions: Transperineal ultrasound predicts endoscopic and histological healing of the rectum. The combination of transperineal ultrasound with transabdominal ultrasound visualises the entire colorectum and is an ideal modality for the treat-totarget strategy. Clinical Trials Registry number UMIN000033611

Are we ready to use activity scores for intestinal ultrasound in ulcerative colitis?

“…5 Recent data employing TPUS in patients with ulcerative proctitis demonstrate excellent correlation between ultrasonographic and endoscopic parameters. 10 In this study, treatment response was detected within 1 week after treatment initiation, further supporting the early use of IUS/TPUS in monitoring active UC wileyonlinelibrary.com/journal/ueg2…”

Measurement of Bowel Wall Thickness by Transabdominal Ultrasonography Is Useful to Detect the Inflammation of Colon in Ulcerative Colitis Patients : A Retrospective Study

“…On the other hand, in another report, the left colon was found to have a higher correlation for BMT and MES. 20 This may be due to differences in patient background, such as the intensity of in ammation and the number of patients analyzed as well as in the variations in the de nition of BMT of the positive ndings. It is recommended that further studies are necessary, including studies at other facilities, to increase the sample size and to clarify further the correlation between BMT and MES.…”

“…The data also suggested that our evaluation method could clearly detect mucosal in ammation. Since the evaluation of mucosal blood ow measurements in patients with UC using the color Doppler method has been reported, 12,20,25,26 evaluating this method, in combination with BWT, may also improve accuracy and stratify the degree of mucosal in ammation, so it may be an examination to be considered in the future.…”

“…Among these values, BWT >3 or 4 mm was the commonly used criterion for a positive nding of in ammation. 9,12,13,20 However, from the receiver operating characteristic curve, the cut-off value of each segment was 2.0 -2.4 mm ( Supplementary Table 1). Thus, 2 mm was considered optimal in this study.…”

“…Each part of the colon was sequentially assessed, except for the rectum because it is di cult to assess. 19,20 We divided the colon into ve segments: ascending colon, right-sided and left-sided transverse colons, descending colon, and sigmoid colon. Using a 7.5 MHz high-frequency linear-array transducer, bowel wall thickness (BWT) was also then measured, which is de ned as the distance from the central hyperechoic line of the lumen (i.e., lumens of digestive tract) to the outer hyperechoic margin of the wall (which refers to the serosa of the digestive tract) ( Figure 1-A, B).…”