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P169 Bowel ultrasound is accurate in assessing disease extent and disease activity in ulcerative colitis

P. Kakkadasam Ramaswamy*1, K. V. Nagarajan1, A. Yelsangikar1, A. Nagar1, N. Bhat1

1Aster CMI Hospital, Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Bangalore, India

Background

Colonoscopy is currently the standard of care for the evaluation of disease extent and activity in ulcerative colitis (UC). Bowel ultrasound (USG) is an easy, cheap, non-invasive tool and can be used to assess disease activity in UC patients.

Methods

Patients who underwent colonoscopy for assessment of disease activity also underwent USG within 2 weeks. Endoscopic activity was graded by the Mayo Endoscopic Score (MES); clinical disease activity was assessed using the Total Mayo Score (TMS). Colonic wall thickness (CWT), loss of bowel wall stratification (WS), Doppler activity (DA) were assessed. DA was evaluated semi-quantitatively by the Limberg score.

Results

Seventeen patients were included in the study, 10/17 (59%) had left-sided colitis, 41% (7/17) had pancolitis. MES of 0, 1, 2, 3 was seen in 1, 3, 8 and 5 patients, respectively. As per TMS, 8 (47%) patients had severe disease, 8 (47%) had mild-to-moderate disease and one patient(6%) was in remission. USG accurately assessed the disease extent in 16 (94%) patients. Median CWT was lower in patients with MES 0-1 when compared with MES 2-3 (3 mm vs. 4.1 mm, p = 0.01). CWT correlated with MES (r = 0.763, p = 0.000) and with TMS (r = 0.748, p = 0.001). DA correlated with MES (r = 0.806, p = 0.001) and TMS (r = 0.789, p = 0.0001). Loss of bowel wall stratification correlated with MES (r = 0.551, p = 0.022) and TMS (r = 0.505, p = 0.039). In patients in whom the bowel wall stratification was preserved, the MES was 1 point lower than in whom it was lost. CWT ≥ 3.2 mm had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 84.5%, 75%, 91.7%, 60%, 82.3%, respectively. Doppler >1 had a sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 100%, 75%, 93%, 100%, 94%, respectively.

SensitivitySpecificityPPVNPVAccuracy
CWT ≥ 3.2 for predicting MES ≥284.57591.76082.3
Doppler >1 for predicting MES≥21007592.810094.1

USG characteristics in predicting active disease.

Conclusion

USG is accurate in assessing disease extent and disease activity in UC and correlates with the Mayo score. Colonic wall thickness, loss of wall stratification and Doppler activity are useful in assessing disease activity and future USG based scores can use these parameters to assess disease activity. Colonic wall thickness ≥ 3.2 mm and Doppler >1 are accurate in predicting MES of ≥2.