Colon to Rectum

Gastroenterology. 2022;163(6):1569–81

de Voogd F, van Wassenaer EA, Mookhoek A, Bots S, van Gennep S, Löwenberg M, D’Haens GR, Gecse KB

Intestinal ultrasound is accurate to determine endoscopic response and remission in patients with moderate-to-severe ulcerative colitis: A longitudinal prospective cohort study


Background and aims: Intestinal ultrasound (IUS) is non-invasive, cost-effective, and accurate to determine disease activity in ulcerative colitis (UC). In this study, the authors prospectively evaluated IUS for treatment response in a longitudinal cohort by using endoscopy and histology as gold standards.
Methods: Consecutive patients with moderate-to-severe UC (endoscopic Mayo score [EMS] ≥ 2) starting tofacitinib treatment were included. Patients were evaluated at baseline and after 8 weeks of tofacitinib induction by means of clinical, biochemical, endoscopic (EMS and UC endoscopic index for severity), histologic (Robarts Histopathologic Index) and IUS assessments. Readers of IUS, endoscopy, and histology were blinded for all other outcomes. The primary outcome was difference in bowel wall thickness (BWT) for endoscopic improvement versus no endoscopic improvement. Endoscopic remission was defined as EMS = 0, improvement as EMS ≤ 1, and response as a decrease of EMS ≥ 1.
Results: 30 patients were included, with 27 patients completing follow-up. BWT correlated with EMS (ρ = 0.68, p < 0.0001), UC endoscopic index for severity (ρ = 0.73, p < 0.0001) and Robarts Histopathologic Index (ρ = 0.49, p = 0.002) at both time points. BWT in the sigmoid was lower in patients with endoscopic remission (1.4 mm vs. 4.0 mm, p = 0.016), endoscopic improvement (1.8 mm vs. 4.5 mm, p < 0.0001) and decrease in BWT was more pronounced in patients with endoscopic response (-58.1% vs. -13.4%, p = 0.018). The most accurate cut-off values for BWT were 2.8 mm (area under the curve [AUC]: 0.87) for endoscopic remission, 3.9 mm (AUC: 0.92) for improvement, and decrease of 32% (AUC: 0.87) for response. The submucosa was the most responsive wall layer.

Conclusion: Intestinal ultrasound, importantly bowel wall thickness as the single most important parameter, is highly accurate to detect treatment response when evaluated against endoscopic outcomes.

Dr. Dr. K.B. Gecse, Department of Gastroenterology and Hepatology, Amsterdam UMC, University of Amsterdam, Location AMC, Amsterdam, The Netherlands,
E-Mail: k.b.gecse@amsterdamumc.nl

DOI: DOI: 10.1053/j.gastro.2022.08.038

Back to overview

this could be of interest:

Effect of colonoscopy screening on risks of colorectal cancer and related death

N Engl J Med. 2022;387(17):1547–56

Efficacy of fecal microbiota transplantation for patients with irritable bowel syndrome at 3 years after transplantation

Gastroenterology. 2022;163(4):982–94.e14

More articles on the topic