Gastrointestinal Ultrasound Can Predict Endoscopic Activity in Crohn’s Disease

Abstract

Purpose To explore the ability of gastrointestinal ultrasound (GIUS) to separate patients in endoscopic remission from patients with active disease in a heterogeneous hospital cohort with Crohn’s disease (CD). Materials and Methods 145 CD patients scheduled for ileocolonoscopy were prospectively included. The endoscopic disease activity was quantified using the Simple Endoscopic Score for Crohn’s disease (SES-CD), and mucosal healing was strictly defined as SES-CD = 0. Ultrasound remission was defined as wall thickness < 3 mm (< 4 mm in the rectum). Additionally, SES-CD was compared to color Doppler, Harvey Bradshaw’s index (HBI), C-reactive protein (CRP) and calprotectin. 23 patients were examined by two investigators for interobserver assessment. Results 102 had active disease and 43 patients were in remission. GIUS yielded a sensitivity of 92.2 % and a specificity of 86 % for wall thickness and a sensitivity of 66.7 % and a specificity of 97.7 % for color Doppler. The sensitivity and specificity were 34.3 % and 88.4 %, respectively, for HBI, 35.7 % and 82.9 %, respectively, for CRP and 55.9 % and 82.1 %, respectively, for calprotectin. The interobserver analysis revealed excellent agreement for wall thickness (k = 0.90) and color Doppler (k = 0.91) measurements. Conclusion GIUS has a high sensitivity for detecting endoscopic activity. Accordingly, bowel ultrasound has the potential to reduce the number of routine ileocolonoscopies in patients with CD.

Impact of intestinal ultrasound with a portable system in the management of Crohn’s disease

“…Other IUS findings can further change management decisions by identifying a more complicated course (such as fistula, abscess, or stenosis). Doppler measurements performed on pathologically thickened bowel walls should be considered for disease-activity quantification, supporting previous reports [ 3 , 4 ]. Furthermore, a recently published TRUST study showed improvement of IUS parameters after treatment, promising the usefulness of IUS as an alternative and fast imaging modality to determine transmural healing [ 20 ].…”

“…The diagnostic capability of IUS examination was high, with a sensitivity of 94% and a specificity of 70.6%, which are in accordance with literature evaluating the performance of the ultrasonographic technique using conventional ultrasound systems in different clinical scenarios [ 2 ]. In a recent study using conventional high-tech ultrasound, Sævik et al [ 3 ] demonstrated that IUS achieved a sensitivity of 92.2% and a specificity of 86% in evaluating disease activity, in which mucosal healing was strictly defined as SES-CD = 0. Based on this high sensitivity, authors suggested that patients with active disease on IUS do not need an ileocolonoscopy as the false-positivity rate was low for IUS; however, patients with ileocolonic disease and normal findings on IUS should be examined using ileocolonoscopy to exclude false negativities.…”

“…In the present study, there was a moderate to good correlation between BWT and SES-CD, except that of the rectum ( Table 3 ). Studies using high-resolution conventional ultrasound systems reported slightly superior correlation between BWT and SES-CD, which also depends on the ultrasonographic BWT cut-off (3 or 4 mm) used or the definition of colonoscopic activity (SES-CD 0 or <3) [ 3 ]. Increased BWT seems the most important difference between patients with active disease and those in remission in our study, which is compatible with previous reports [ 2–4 ].…”

“…Third, all ultrasound examinations were performed by the same gastroenterologist in the present study and no intra- or inter-observer analysis was performed. However, it is reported that the inter-observer agreement of IUS is good to excellent in both newly diagnosed and relapsing patients [ 3 , 27 ].…”

“…Intestinal ultrasound (IUS) has become an increasingly used diagnostic modality for the management of CD patients due to its high sensitivity and specificity in the detection of intestinal inflammatory activity and disease extent [ 2 ]. In a recent report, high sensitivity for detecting endoscopic activity was further demonstrated in a heterogeneous patient cohort with different disease phenotypes, and its potential to reduce the number of routine ileocolonoscopies for patient monitoring was suggested [ 3 ].…”