Gastroenterology, Department of Clinical Medicine and Surgery, School of Medicine Federico II of Naples, Italy.
Gastroenterology, P.O. "Santa Maria Delle Grazie", Pozzuoli [Na], Italy.
J Crohns Colitis. 2023 Jul 5;17(7):1089-1096. doi: 10.1093/ecco-jcc/jjad024.
Ulcerative colitis [UC] assessment still requires ileocolonoscopy [IC]. Intestinal ultrasound [IUS] has emerged as a non-invasive assessment tool, and the Milan Ultrasound Criteria [MUC] score has been validated to estimate and grade UC disease activity. Recently, hand-held IUS [HHIUS] has been used in several clinical settings, but data about its use in UC are limited. We aimed to evaluate the diagnostic accuracy of HHIUS compared with conventional IUS in detecting UC extension and activity.
From November 2021 to September 2022, we prospectively enrolled UC patients afferent to our third-level IBD Unit for IC evaluation. Patients underwent IC, HHIUS, and IUS. Ultrasound activity was defined by MUC >6.2, and endoscopic activity was defined by a Mayo endoscopic score [MES] >1. Cohen's k test was applied to test the concordance between IUS-MUC and HHIUS-MUC after MUC dichotomisation [MUC >6.2, yes/no].
In all, 86 patients with UC were enrolled. No significant difference was recorded between IUS and HHIUS at the per-segment extension [p = N.S.], and both procedures were comparable in terms of results of bowel wall thickness [BWT] and bowel wall stratification [BWS] assessment [p = N.S.]. IUS and HHIUS displayed excellent agreement when the MUC score system was applied [k = 0.86, p <0.01].
Hand-held intestinal ultrasound and IUS are comparable in UC extension definition and MUC evaluation. HHIUS could be reliable for detecting disease activity and estimating its extension, providing close monitoring. It also represents a non-invasive, easily practicable investigation, allowing immediate medical decisions with significant time and cost advantages.
溃疡性结肠炎[UC]的评估仍需要进行回结肠镜检查[IC]。肠超声[IUS]已成为一种非侵入性评估工具，米兰超声标准[MUC]评分已被验证用于估计和分级 UC 疾病活动度。最近，手持式肠超声[HHIUS]已在多个临床环境中使用，但关于其在 UC 中的应用的数据有限。我们旨在评估 HHIUS 与常规 IUS 在检测 UC 延伸和活动度方面的诊断准确性。
2021 年 11 月至 2022 年 9 月，我们前瞻性地招募了我们三级 IBD 病房接受 IC 评估的 UC 患者。患者接受了 IC、HHIUS 和 IUS。超声活动度定义为 MUC>6.2，内镜活动度定义为 Mayo 内镜评分[MES]>1。在 MUC 二分法[MUC>6.2，是/否]后，应用 Cohen's k 检验来测试 IUS-MUC 和 HHIUS-MUC 之间的一致性。
共纳入 86 例 UC 患者。在分段延伸方面，IUS 和 HHIUS 之间没有显著差异[p=无统计学意义]，并且在肠壁厚度[BWT]和肠壁分层[BWS]评估方面，两种方法的结果相当[p=无统计学意义]。当应用 MUC 评分系统时，IUS 和 HHIUS 显示出极好的一致性[k=0.86，p<0.01]。
手持式肠超声和 IUS 在 UC 延伸定义和 MUC 评估方面具有可比性。HHIUS 可能是检测疾病活动度和估计其延伸的可靠方法，提供了密切监测。它还代表了一种非侵入性、易于实施的检查方法，具有显著的时间和成本优势，可以立即做出医疗决策。
