Takeuchi Keiko, Inokuchi Toshihiro, Takahara Masahiro, Ohmori Masayasu, Yasutomi Eriko, Oka Shohei, Igawa Shoko, Takei Kensuke, Baba Yuki, Kawano Seiji, Yamasaki Yasushi, Kinugasa Hideaki, Harada Keita, Hiraoka Sakiko, Okada Hiroyuki
Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
J Ultrasound Med. 2023 Feb;42(2):373-383. doi: 10.1002/jum.16038. Epub 2022 Jun 11.
Double balloon enteroscopy (DBE) with retrograde contrast is useful as a monitoring tool for small intestinal lesions in Crohn's disease (CD), but these are burdensome for patients. Intestinal ultrasound (IUS) can be used with ease in daily clinical practice, but there is less evidence regarding the accuracy of detection of small intestinal stenosis in CD. This study aimed to examine the diagnostic power of IUS for small intestinal stenosis in patients with CD.
The findings of DBE and IUS in 86 patients with CD with small intestinal lesions were evaluated. Using DBE as the reference standard, we examined the detection rate of IUS for small intestinal stenosis. We evaluated three parameters: luminal narrowing, prestenotic dilation, and to-and-fro movement for determining stenosis using IUS. In addition, we compared the characteristics between the stenosis-detectable and stenosis-undetectable groups by IUS.
Of the 86 patients, 30 had small intestinal stenosis. In IUS findings, when lesions that met two or more of the three parameters were judged as stenosis, the detection rate was 70.0% for sensitivity, 98.2% for specificity, and 88.4% for accuracy. Moreover, there were patients with a younger age at diagnosis (P < 0.05) and more ileocolonic disease location (P < 0.05) in the stenosis-detectable group by IUS. The stenoses detected by IUS were significantly longer than those undetected by IUS (14.1 mm versus 5.2 mm, P < 0.05).
IUS delivered reliable results for clinically important small intestinal stenosis of CD with high diagnostic accuracy.
逆行造影双气囊小肠镜（DBE）是监测克罗恩病（CD）小肠病变的一种有用工具，但对患者来说负担较重。肠道超声（IUS）在日常临床实践中使用方便，但关于CD小肠狭窄检测准确性的证据较少。本研究旨在探讨IUS对CD患者小肠狭窄的诊断能力。
评估86例有小肠病变的CD患者的DBE和IUS检查结果。以DBE作为参考标准，我们检查了IUS对小肠狭窄的检出率。我们评估了三个参数：管腔狭窄、狭窄前扩张以及使用IUS确定狭窄的来回移动情况。此外，我们比较了IUS可检测到狭窄和未检测到狭窄两组之间的特征。
86例患者中，30例有小肠狭窄。在IUS检查结果中，当符合三个参数中两个或更多参数的病变被判定为狭窄时，灵敏度为70.0%，特异度为98.2%，准确度为88.4%。此外，IUS可检测到狭窄的组中患者诊断时年龄较小（P < 0.05）且回结肠病变部位更多（P < 0.05）。IUS检测到的狭窄明显长于未检测到的狭窄（14.1毫米对5.2毫米，P < 0.05）。
IUS对CD临床上重要的小肠狭窄诊断准确性高，结果可靠。
