The value of intestinal ultrasound scores in predicting long-term endoscopic outcomes in ulcerative colitis.

The value of intestinal ultrasound (IUS) in predicting treatment outcomes in ulcerative colitis (UC) remains underexplored. To compare the predictive accuracy of representative IUS scores for long-term endoscopic outcomes in UC. A retrospective observational study. Consecutive UC patients initiating biologics/small-molecule drugs were enrolled. IUS examinations were performed at baseline, 4-6 months, and at the first colonoscopy reassessment (12-30 months). IUS images were reviewed, and bowel wall thickness (BWT), Milan ultrasound criteria (MUC), and International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) were recorded. Endoscopic response was assessed using the Mayo Endoscopic Score (MES), with remission defined as MES = 0 and improvement as MES ⩽1. Forty-nine patients were included. All three IUS scores showed significant correlations with concurrent MES, with IBUS-SAS demonstrating the strongest association (BWT, ρ = 0.54; MUC, ρ = 0.55; IBUS-SAS, ρ = 0.69). IBUS-SAS at 4-6 months was the most accurate predictor of long-term endoscopic remission (area under the curve (AUC) 0.767) and endoscopic improvement (AUC 0.770). On multivariable analysis, an IBUS-SAS score <25.5 at 4-6 months was the only independent predictor of endoscopic remission (odds ratio (OR) 7.6, p = 0.005), while an IBUS-SAS score <38.0 was the only independent predictor of endoscopic improvement (OR 5.8, p = 0.006). The IBUS-SAS score at early follow-up may serve as a valuable predictor of long-term endoscopic outcomes in UC.