|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 4 | Page : 313-314
Role of EUS in idiopathic ulcerative colitis
Surinder Singh Rana1, Bhaskar Kante1, Jimil Shah1, Ritambhra Nada2, Navin Kalra3, Rajesh Gupta4
1 Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
3 Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||06-Nov-2020|
|Date of Acceptance||23-Mar-2021|
|Date of Web Publication||26-Jun-2021|
Prof. Surinder Singh Rana
Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Rana SS, Kante B, Shah J, Nada R, Kalra N, Gupta R. Role of EUS in idiopathic ulcerative colitis. Endosc Ultrasound 2021;10:313-4
EUS enables measurement of transmural inflammation and activity endo-luminally in patients with inflammatory bowel disease (IBD). It enables measurements of mucosal thickness (MT), submucosal thickness (SMT), total wall thickness (TWT), and loss of intestinal wall stratification. Previously, few studies have shown utility of EUS in predicting the disease activity in patients with IBD. TWT has been found to be elevated in patients with active IBD compared to healthy controls. Moreover, increased rectal wall thickness as measured by EUS has also been shown to predict disease relapse in patient with IBD.,,, However, these studies have been done mostly on patients with Crohn's disease and various EUS parameters have not been correlated with different disease activity or endoscopic activity. We conducted a prospective study to correlate various EUS parameters with clinical activity, endoscopic and histological scores in patients with ulcerative colitis (UC).
Consecutive patients with UC were prospectively included in study after taking informed and the study protocol was approved by the Institute Ethics Committee. The UC clinical activity was noted as per Truelove and Witts criteria and endoscopic activity was recorded according to Mayo endoscopic score., Patients underwent rectal EUS examination followed by sigmoidoscopy/colonoscopy after standard oral polyethylene glycol preparation. Rectal EUS was done using radial scanning echoendoscope and the endosonologist was blinded to the clinical and endoscopic disease activity. The MT, SMT and TWT were noted [Figure 1]. The presence or absence of intestinal layer stratification was also recorded in all patients. All measurements were repeated three times in sigmoid colon to reduce sampling errors and mean value of the three values was taken as the final value.
|Figure 1: (a) EUS in patient with ulcerative colitis showing thickened mucosa and submucosa; (b) EUS in patient with ulcerative colitis showing thickened wall with preserved wall stratification; (c) EUS in patient with ulcerative colitis showing thickened wall with loss of wall stratification|
Click here to view
Total of 48 patients (mean age: 40.9 ± 13.0 years; 31 males) of UC were studied. The mean TWT in patients with UC was 3.54 ± 1.22 mm with patients having clinically severe disease having significantly higher mean TWT (4.26 ± 1.26 mm) compared to patients in remission (2.87 ± 0.80 mm; P < 0.05) or patients having mild disease (3.1 ± 0.77 mm; P < 0.05). However, difference was not significant when it was compared to patients with moderate disease (3.62 ± 1.53 mm; P > 0.05). The correlation between TWT and clinical severity was significant (P = 0.001; correlation coefficient 0.453). Patients with severe disease endoscopically were also found to have higher mean TWT (4.51 ± 1.33 mm) compared to patients in remission (2.95 ± 0.45 mm; P < 0.05), patients with mild disease (2.62 ± 0.80 mm; P < 0.05) or patients with moderate disease (3.27 ± 0.74 mm; P < 0.05). Correlation between TWT and endoscopic severity was found to be significant (P < 0.001, correlation coefficient 0.551). The mean MT + SMT in patients with UC was 2.30 ± 0.95 mm with patients with clinically severe disease having significantly higher MT + SMT (2.88 ± 1.16 mm) compared to patients with mild disease (1.79 ± 0.52 mm; P < 0.05) The correlation between MT + SMT and clinical severity was found to be significant (P = 0.008, correlation coefficient 0.37). The mean MT + SMT was significantly higher in patients with endoscopic severe disease (2.94 ± 1.14 mm) compared to patients in remission (1.82 ± 0.53 mm; P < 0.05), patients with mild disease activity (1.89 ± 0.85 mm; P < 0.05) or patients with moderate disease activity (2.01 ± 0.47 mm; P < 0.05). MT + SMT significantly correlated with endoscopic severity (P = 0.002, correlation coefficient 0.439). Patients in clinical remission (77.8%), mild disease (78.6%) or moderate disease (77.8%) were more likely to have preserved intestinal wall stratification compared to patients with severe disease (43.8%). However, this difference was not statistically significant and no significant correlation was not found between clinical severity and intestinal layer stratification (P = 0.129). However, patients with severe disease on endoscopic examination were more likely to have loss of intestinal stratification (64.7%) compared to patients with mild (20.0%) or moderate disease (11.8%) (P < 0.05). Loss of intestinal wall stratification correlated with endoscopic severity (P < 0.05; r = 0.342).
In conclusion, EUS guided measurement of TWT, mucosal and submucosal wall thickness and loss of intestinal wall stratification correlated well with clinical severity and endoscopic scoring in patients with UC. They may be also useful in judging depth of inflammation as well as response to therapy which requires further evaluation in a prospective studies.
Financial support and sponsorship
Conflicts of interest
Surinder S. Rana is an Editorial Board Member of Endoscopic Ultrasound. The article was subject to the journal's standard procedures, with peer review handled independently of this Member and his research groups. There are no other conflicts of interest.
| References|| |
Ellrichmann M, Wietzke-Braun P, Dhar S, et al
. Endoscopic ultrasound of the colon for the differentiation of Crohn's disease and ulcerative colitis in comparison with healthy controls. Aliment Pharmacol Ther
Higaki S, Nohara H, Saitoh Y, et al
. Increased rectal wall thickness may predict relapse in ulcerative colitis: A pilot follow-up study by ultrasonographic colonoscopy. Endoscopy
Yoshizawa S, Kobayashi K, Katsumata T, et al
. Clinical usefulness of EUS for active ulcerative colitis. Gastrointest Endosc
Tsuga K, Haruma K, Fujimura J, et al
. Evaluation of the colorectal wall in normal subjects and patients with ulcerative colitis using an ultrasonic catheter probe. Gastrointest Endosc
Hurlstone DP, Sanders DS, Lobo AJ, et al
. Prospective evaluation of high-frequency mini-probe ultrasound colonoscopic imaging in ulcerative colitis: A valid tool for predicting clinical severity. Eur J Gastroenterol Hepatol
Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med
Truelove SC, Witts LJ. Cortisone in ulcerative colitis; final report on a therapeutic trial. Br Med J