A pilot study of transrectal endoscopic ultrasound elastography in inflammatory bowel disease

Abstract

BackgroundUsing standard diagnostic algorithms it is not always possible to establish the correct phenotype of inflammatory bowel disease which is essential for therapeutical decisions. Endoscopic ultrasound elastography is a new endoscopic procedure which can differentiate the stiffness of normal and pathological tissue by ultrasound. Therefore, we aimed to investigate the role of transrectal ultrasound elastography in distiction between Crohn's disease and ulcerative colitis.MethodsA total 30 Crohn's disease, 25 ulcerative colitis, and 28 non-inflammatory bowel disease controls were included. Transrectal ultrasound elastography was performed in all patients and controls. In all ulcerative coltis patients and 80% of Crohn's disease patients endoscopy was performed to assess disease activity in the rectum.ResultsSignificant difference in rectal wall thickness and strain ratio was detected between patients with Crohn's disease and controls (p = 0.0001). CD patients with active disease had higher strain ratio than patients in remission (p = 0.02). In ulcerative colitis group a significant difference in rectal wall thickness was found between controls and patients with active disease (p = 0.03). A significant difference in rectal wall thickness (p = 0.02) and strain ratio (p = 0.0001) was detected between Crohn's disease and ulcerative colitis patient group. Crohn's disease patients with active disease had a significantly higher strain ratio compared to ulcerative colitis patients with active disease (p = 0.0001).ConclusionTransrectal ultrasound elastography seems to be a promising new diagnostic tool in the field of inflammatory bowel disease. Further study on a larger cohort of patients is needed to definitely assess the role of transrectal ultrasound elastography in inflammatory bowel disease.

EFSUMB Guidelines and Recommendations on the Clinical Use of Ultrasound Elastography.Part 2: Clinical Applications

“…Strain elastography has been tested in this setting and helps the distinction between these two conditions, since fibrotic stenoses appear stiff and inflammatory stenoses soft [114]. Furthermore, patients with active Crohn's disease have a higher strain ratio between the inflamed and normal regions than patients in remission [115] and than patients with active ulcerative colitis. In a study on inflammatory bowel disease, the findings on elastography were significantly correlated with the endoscopic findings [116].…”

Strain Assessment in Surgically Resected Inflammatory and Neoplastic Bowel Lesions

“…We selected Crohn's lesions because they are transmural and expand the bowel wall in a similar manner to neoplasias. Rustemovic et al have studied patients with ulcerative colitis and compared them to patients with Crohn's disease and healthy controls in vivo [39]. They found a significantly higher SR in Crohn's patients than in ulcerative colitis patients with active rec-tal disease.…”

Endoscopic ultrasound elastography

“…Quantitative elastography using the strain ratio differentiated between adenomas and adenocarcinomas with a sensitivity of 0.93, a specificity of 0.96, and an accuracy of 0.94 61. In a recent pilot study, EUS evaluation of rectal wall thickness and the strain ratio has been investigated for diagnosing inflammatory bowel disease and differentiating Crohn's disease from ulcerative colitis 62. Patients with Crohn's disease had significantly higher strain ratios both than the controls and patients with ulcerative colitis, but there was no difference between the strain ratios of patients with ulcerative colitis and the controls.…”