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Abstract Background and Aims Though colonoscopy plays a crucial role in assessing active ulcerative colitis aUC, its scope is limited to the mucosal surface. Endoscopic ultrasound EUS coupled with contrast-enhancement dCEUS can precisely quantify bowel wall thickness and microvascular circulation, potentially enabling the quantitative evaluation of inflammation. We conducted a prospective, longitudinal study to assess therapy response using dCEUS in aUC patients undergoing treatment with adalimumab ADA or infliximab IFX. Methods Thirty ADA- and 15 IFX-treated aUC patients were examined at baseline and at 2, 6, and 14 weeks of therapy and 48 weeks of follow-up. Bowel wall thickness BWT was measured by EUS in the rectum. Vascularity was quantified by dCEUS using rise time RT and time to peak TTP. Therapy response was defined after 14 weeks using the Mayo Score. Results Patients with aUC displayed a mean BWT of 3.9 ± 0.9 mm. In case of response to ADA/IFX a significant reduction in BWT was observed after 2 weeks p = 0.04, whereas non-responders displayed no significant changes. The TTP was notably accelerated at baseline and significantly normalized by week 2 in responders p = 0.001, while non-responders exhibited no significant alterations p = 0.9. At week 2, the endoscopic Mayo score did not exhibit any changes, thus failing to predict treatment responses. Conclusion dCEUS enables the early detection of therapy response in patients with aUC, which serves as a predictive marker for long-term clinical success. Therefore, dCEUS serves as a diagnostic tool for assessing the probability of future therapy success.
Ellrichmann et al. (Fri,) studied this question.