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Ultraschall Med 2022; 43(01): 82-89
DOI: 10.1055/a-1149-9092
Original Article

Gastrointestinal Ultrasound Can Predict Endoscopic Activity in Crohn’s Disease

Gastrointestinaler Ultraschall zur Prädiktion der endoskopischen Krankheitsaktivität bei Morbus Crohn
Fredrik Sævik
1   National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
2   Department of Clinical Medicine, University of Bergen, Norway
,
Odd Helge Gilja
1   National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
2   Department of Clinical Medicine, University of Bergen, Norway
,
Kim Nylund
1   National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
2   Department of Clinical Medicine, University of Bergen, Norway
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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.

Zusammenfassung

Ziel Untersuchung, inwiefern der gastrointestinale Ultraschall (GIUS) in einer heterogenen Krankenhauskohorte mit Morbus Crohn (CD) in der Lage ist, Patienten in endoskopischer Remission von Patienten mit aktiver Erkrankung zu trennen.

Material und Methoden Es wurden prospektiv 145 CD-Patienten, die für eine Ileokoloskopie vorgesehen waren, eingeschlossen. Die endoskopische Krankheitsaktivität wurde mithilfe des „Simple Endoscopic Score for Crohn’s disease“ (SES-CD) quantifiziert, und die Mukosaheilung wurde streng als SES-CD = 0 definiert. Die Remission wurde im Ultraschall als Wandstärke < 3 mm (< 4 mm im Rektum) definiert. Zusätzlich wurde der SES-CD mit Farbdoppler, Harvey-Bradshaw-Index (HBI), C-reaktivem Protein (CRP) und Calprotectin verglichen. Für die Interobserver-Analyse wurden 23 Patienten von 2 Beobachtern untersucht.

Ergebnis Insgesamt 102 Patienten hatten eine aktive Erkrankung und 43 befanden sich in Remission. Der GIUS zeigte eine Sensitivität von 92,2 % und eine Spezifität von 86 % für die Wanddicke und eine Sensitivität von 66,7 % und eine Spezifität von 97,7 % für den Farbdoppler. Für den HBI lag die Sensitivität bei 34,3 % und die Spezifität bei 88,4 %, für CRP betrug die Sensitivität 35,7 % und die Spezifität 82,9 % und für Calprotectin lag die Sensitivität bei 55,9 % und die Spezifität 82,1 %. Die Interobserver-Analyse ergab eine ausgezeichnete Übereinstimmung für die Wanddicke- (k = 0,90) und Farbdoppler-Messungen (k = 0,91).

Schlussfolgerung GIUS hat eine hohe Sensitivität für den Nachweis der endoskopischen Aktivität. Dementsprechend hat der gastrointestinale Ultraschall das Potenzial, routinemäßig durchgeführte Ileokoloskopien bei Patienten mit CD zu reduzieren.

Key words

Crohn’s disease - gastrointestinal ultrasound - monitoring - mucosal healing


Publication History

Received: 29 November 2019

Accepted: 19 March 2020

Article published online:
24 April 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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