Abstract Background Timely disease monitoring and prevention, as well as early identification of relapses, are of paramount importance in the management of IBD. Available biomarkers and cross-sectional imaging are expensive and not easily available. Intestinal ultrasound (IUS) is increasingly recognized as an inexpensive tool for disease activity monitoring.1 We aimed to assess the usefulness of IUS for monitoring disease activity in Ulcerative Colitis (UC). Methods This was a prospective single-center study conducted at CMCTH, Bharatpur, Nepal. All the consecutive patients with UC who were eligible to undergo colonoscopy or sigmoidoscopy were considered for this study. Endoscopic disease activity was recorded by the UCEIS score. Intestinal ultrasound was performed within 48 hours preceding or after the endoscopic assessment by a consultant gastroenterologist and/or radiologist. The Bowel wall thickness (BWT), modified Limberg score, bowel wall stratification, inflammatory fat, lymph nodes, and ascites were the parameters assessed on IUS. A BWT cut off at 3mm, and Milan Ultrasound Criteria (MUC) cut off at 6.2 were assessed for their accuracy in discriminating active and inactive diseases.2,3 Results Among 48 UC patients mean age: 44.54 ± 16.23 years, male: 27 (56.2%), left-sided colitis (E2) and extensive colitis (E3) were present in 33(68.7%) and 15 (31.2%) patients, respectively. Endoscopic remission (UCEIS:0-1), mild (UCEIS:2-4), moderate (UCEIS:5-6), and severe (UCEIS: 7-8) were seen in 11 (22.9%), 17 (35.4%), 17 (35.4%), and 3 (6.2%) patients, respectively. BWT and MUC significantly correlated with endoscopic disease activity, with an AUROC of 0.92 and 0.88, respectively. BWT cut-off value at 3 mm had sensitivity, specificity, positive likelihood, and negative likelihood ratios of 70.2%, 90.9%, 7.7, and 0.32, respectively. Similarly, MUC at cut-off 6.2 had a sensitivity of 48.6%, specificity of 90.9%, positive likelihood ratio of 5.3, and negative likelihood ratio of 0.56. Conclusion In this prospective study, the bowel wall thickness (BWT) and Milan ultrasound criteria (MUC) correlated significantly with endoscopic disease activity. However, the BWT cut-off at 3 mm and the MUC cut-off at 6.2 had poor to modest sensitivity and excellent specificity in detecting active disease. Further prospective data in large and multicenter studies are required to define a cut-off value. References: 1. Chavannes M, Dolinger MT, Cohen-Mekelburg S, Abraham B. AGA Clinical Practice Update on the Role of Intestinal Ultrasound in Inflammatory Bowel Disease: Commentary. Clinical Gastroenterology and Hepatology. 2024;22(9):1790-1795.e1. doi:10.1016/j.cgh.2024.04.039 2. Allocca M, Fiorino G, Bonovas S, et al. Accuracy of Humanitas Ultrasound Criteria in Assessing Disease Activity and Severity in Ulcerative Colitis: A Prospective Study. J Crohns Colitis. 2018;12(12):1385-1391. doi:10.1093/ecco-jcc/jjy107 3. Jauregui-Amezaga A, Rimola J. Role of Intestinal Ultrasound in the Management of Patients with Inflammatory Bowel Disease. Life (Basel). 2021;11(7):603. doi:10.3390/life11070603 Conflict of interest: Dr. Ranjan, Mukesh Kumar: None Maharjan, Bigyan: None Poudel, Bikash: None Neupane, Pradeep: None Khadka, Chetan: None
Ranjan et al. (Thu,) studied this question.