Usefulness of transabdominal ultrasonography for assessing ulcerative colitis: a prospective, multicenter study

Kinoshita, Kenji; Katsurada, Takehiko; Nishida, Mutsumi; Omotehara, Satomi; Onishi, Reizo; Mabe, Katsuhiro; Onodera, A; Sato, Mami; Eto, Kazunori; Suya, Mitsutoshi; Maemoto, Atsuo; Hasegawa, Tomohiko; Yamamoto, Junji; Mitsumori, Daiki; Yoshii, Shinji; Ono, Kota; Sakamoto, Naoya

doi:10.1007/s00535-018-01534-w

Cited by 41 publications

(55 citation statements)

References 41 publications

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“…This limitation may be justiﬁed by the objective of our study which was the use of IUS examination in routine monitoring of patients with UC rather than determining the accuracy of IUS compared with other diagnostic procedures. This comparison has already been the subject of several previous studies 15 23 27 41 45 46. However, investigators documented endoscopies, performed as part of clinical routine care, and we found highly significant correlations between the increased BWT and the endoscopic Mayo subscore.…”

Section: Discussionsupporting

confidence: 73%

Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study

Maaser¹,

Petersen²,

Helwig

et al. 2019

Gut

132

124

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ObjectiveProspective evaluation of intestinal ultrasound (IUS) for disease monitoring of patients with ulcerative colitis (UC) in routine medical practice.DesignTRansabdominal Ultrasonography of the bowel in Subjects with IBD To monitor disease activity with UC (TRUST&UC) was a prospective, observational study at 42 German inflammatory bowel disease-specialised centres representing different care levels. Patients with a diagnosis of a proctosigmoiditis, left-sided colitis or pancolitis currently in clinical relapse (defined as Short Clinical Colitis Activity Index ≥5) were enrolled consecutively. Disease activity and vascularisation within the affected bowel wall areas were assessed by duplex/Colour Doppler ultrasonography.ResultsAt baseline, 88.5% (n=224) of the patients had an increased bowel wall thickness (BWT) in the descending or sigmoid colon. Even within the first 2 weeks of the study, the percentage of patients with an increased BWT in the sigmoid or descending colon decreased significantly (sigmoid colon 89.3%–38.6%; descending colon 83.0%–42.9%; p<0.001 each) and remained low at week 6 and 12 (sigmoid colon 35.4% and 32.0%; descending colon 43.4% and 37.6%; p<0.001 each). Normalisation of BWT and clinical response after 12 weeks of treatment showed a high correlation (90.5% of patients with normalised BWT had symptomatic response vs 9.5% without symptomatic response; p<0.001).ConclusionsIUS may be preferred in general practice in a point-of-care setting for monitoring the disease course and for assessing short-term treatment response. Our findings give rise to the assumption that monitoring BWT alone has the potential to predict the therapeutic response, which has to be verified in future studies.

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Section: Discussionsupporting

confidence: 73%

Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study

Maaser¹,

Petersen²,

Helwig

et al. 2019

Gut

132

124

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“…Ultrasonography may be an ideal modality to address the limitations of both endoscopy and biomarkers. Transabdominal ultrasound has been reported to well correlate with the endoscopic severity of UC while it can visualise the extent and severity with very high patients' acceptability 4‐6 . Bowel wall thickening, loss of wall stratification and increased mucosal blood flow reflect the severity of inflammation and some scores have been developed to correlate with endoscopic severity 4,7,8 .…”

Section: Introductionmentioning

confidence: 99%

Transperineal ultrasound predicts endoscopic and histological healing in ulcerative colitis

Sagami

Kobayashi

Aihara

et al. 2020

Aliment Pharmacol Ther

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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

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“…On the other hand, the myriad advantages of US include lack of radiation exposure, non-invasiveness, and costeffectiveness [12,17]. US has recently garnered interest as a useful imaging modality for the diagnosis and follow-up of inflammatory bowel disease [4,[13][14][15][18][19][20]. A PubMed search for studies published from inception to April 2019, with the terms "ultrasonography," "immune checkpoint inhibitor," and "colitis," revealed a lack of reports detailing the US findings of ICI-related colitis.…”

Section: Discussionmentioning

confidence: 99%

“…Colitis is a well-known irAE, for which a variety of colnoscopy (CS) findings have been reported [1,2]. Moreover, transabdominal ultrasonography (US) has recently been used for diagnosing and following-up on gastrointestinal diseases [3,4]. Herein, we reported our experience with ICIrelated colitis and successful followed-up with US.…”

Section: Introductionmentioning

confidence: 97%

Immune Checkpoint Inhibitor-Induced Colitis Successfully Followed up by Ultrasonography

Omotehara

Nishida

Nagashima

et al. 2020

SN Compr. Clin. Med.

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Nivolumab is an immune checkpoint inhibitor (ICI), which is used for treatment of advanced malignancies. Diarrhea is a typical adverse effect of ICIs. Several endoscopic features of ICI-related colitis have been reported. Herein, we reported a case of ICI-related colitis, with successful follow-up using ultrasonography (US). A 54-year-old woman, diagnosed with renal cell carcinoma, underwent radical nephrectomy. Multiple liver and bone metastases appeared 6 months after surgery. She was prescribed sunitinib, which was discontinued, because of severe diarrhea. She was prescribed nivolumab after 1 week. However, she was hospitalized 9 days later, due to fever and diarrhea. US showed diffuse wall thickening from the cecum to the rectum. The wall layer structures were preserved, and thickening was observed mainly in the submucosa, but not in the mucosa, without a decrease in the echo level. Subsequently, sigmoidoscopy was performed. Severe edema was observed in the mucosa, without any erosion and granularity. She was clinically diagnosed with ICI-related colitis, and steroid therapy was administered. One week after steroid therapy, the diarrhea improved, and the earlier findings showed marked improvement on US. After another week of reduced steroid dose, US revealed further improvement, and she was discharged. Keywords Immune checkpoint inhibitor. Nivolumab. Immune-related adverse effect. Colitis. Ultrasonography This article is part of the Topical Collection on Imaging

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Usefulness of transabdominal ultrasonography for assessing ulcerative colitis: a prospective, multicenter study

Cited by 41 publications

References 41 publications

Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study

Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study

Transperineal ultrasound predicts endoscopic and histological healing in ulcerative colitis

Immune Checkpoint Inhibitor-Induced Colitis Successfully Followed up by Ultrasonography

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