Lew Ronald J, Ginsberg Gregory G
Hospital of the University of Pennsylvania, Division of Gastroenterology, University of Pennsylvania, 3400 Spruce Street, 3 Ravdin Building, Philadelphia, PA 19104, USA.
Gastrointest Endosc Clin N Am. 2002 Jul;12(3):561-71. doi: 10.1016/s1052-5157(02)00016-8.
Ultrasonography has been applied to the diagnosis and management of inflammatory bowel disease for over 20 years. The combination of endoscopy with ultrasound has resulted in the application of intraluminal sonographic imaging to multiple diseases, including inflammatory bowel disease. Initial efforts were focused on the sonographic assessment of disease severity as based on bowel wall thickness, but this has been inconsistently demonstrated. Furthermore, disease severity is a clinical assessment that is based on both clinical and imaging studies. Recognizing that Crohn's disease tends to be transmural and ulcerative colitis a superficial mucosal inflammatory process, hopes were raised that endosonography would be effective in discriminating cases of otherwise indeterminate colitis. Efforts to demonstrate this, however, have been largely disappointing, and EUS plays a limited role in discriminating ulcerative colitis from Crohn's disease. On a more positive note, EUS evaluation of perirectal and perianal complications of Crohn's disease has been demonstrated to be superior to fistulography, CT, and equal to or superior to MRI. Because accurate anatomic information is required to guide surgical therapy of these lesions, EUS has the potential to emerge as a powerful imaging tool in the management of perianorectal Crohn's disease.
超声检查应用于炎症性肠病的诊断和管理已有20多年。内镜检查与超声检查相结合，使得腔内超声成像应用于多种疾病，包括炎症性肠病。最初的研究重点是基于肠壁厚度的疾病严重程度的超声评估，但这一点尚未得到一致证实。此外，疾病严重程度是基于临床和影像学研究的临床评估。认识到克罗恩病往往是透壁性的，而溃疡性结肠炎是浅表性黏膜炎症过程，人们曾希望内镜超声检查能有效鉴别其他难以确诊的结肠炎病例。然而，证明这一点的努力大多令人失望，内镜超声检查在区分溃疡性结肠炎和克罗恩病方面作用有限。更积极的一面是，内镜超声检查对克罗恩病直肠周围和肛周并发症的评估已被证明优于瘘管造影、CT，且等同于或优于MRI。由于这些病变的手术治疗需要准确的解剖信息，内镜超声检查有可能成为肛周克罗恩病管理中一种强大的成像工具。
