The role of endoscopic ultrasound in inflammatory bowel disease
Section snippets
Characterization of luminal IBD with EUS
The standard imaging modalities for assessing and diagnosing both ulcerative colitis and Crohn's disease include barium radiography and computed tomography. Luminal imaging is best accomplished with endoscopy. In the case of colorectal manifestations of inflammatory bowel disease, colonoscopy affords the best modality for assessing mucosal inflammation and/or the presence of ulcerations, pseudopolyps, or mass lesions. Because colonoscopy only provides a visual image of the mucosa,
Differentiating ulcerative colitis from Crohn's Colitis with EUS
The inflammatory changes in ulcerative colitis are typically limited to the mucosa and upper submucosa, sparing the muscularis propria. In contrast, Crohn's disease is felt to be a transmural disease, with inflammation demonstrable in all of the bowel wall layers. Apart from histopathologic differences, patients with ulcerative colitis have mucosal changes extending from the rectum, and continuing proximally in the colon. Crohn's disease, even when confined to the colon, classically spares the
EUS and extraintestinal manifestations of Crohn's disease
Patients with Crohn's disease will develop perianal complications in 32 to 50% of cases [18], [19]. Abscesses and fistulas commonly occur in the anorectal region, especially in patients with rectal disease [20]. Because surgical intervention in the perirectal and perianal regions may be associated with an increased risk of fecal incontinence [20], [21], operative management is reserved for cases that are refractory to medical management (eg, with infliximab). Accurate imaging of the perianal
Summary
Ultrasonography has been applied to the diagnosis and management of inflammatory bowel disease for over 20 years. The combination of endoscopy with ultrasound has resulted in the application of intraluminal sonographic imaging to multiple diseases, including inflammatory bowel disease. Initial efforts were focused on the sonographic assessment of disease severity as based on bowel wall thickness, but this has been inconsistently demonstrated. Furthermore, disease severity is a clinical
References (27)
- et al.
Detection of Crohn's disease by ultrasound
Gastroenterology
(1982) - et al.
Value of transrectal ultrasonography in Crohn's disease
Gastroenterology
(1991) Ultrasound demonstration of bowel wall thickness in inflammatory bowel disease
Clin Radiol
(1984)Endoscopic ultrasonography in inflammatory bowel disease, para-colorectal inflammatory pathology and extramural abnormalities
Gastrointest Endosc Clin North Am
(1995)- et al.
Evaluation of the colorectal wall in normal subjects and patients with ulcerative colitis using an ultrasonic catheter probe
Gastrointest Endosc
(1998) - et al.
Catheter probe-assisted endoluminal US in inflammatory bowel disease
Gastrointest Endosc
(1999) - et al.
National Cooperative Crohn's Disease Study: extraintestinal manifestations and perianal complications
Gastroenterology
(1979) - et al.
A comparison of endoscopic ultrasound, magnetic resonance imaging, and exam under anesthesia for evaluation of Crohn's perianal fistulas
Gastroenterology
(2001) - et al.
Ultrasonic evaluation of the stomach, small bowel, and colon
Radiology
(1979) - et al.
Ultrasonography and endosonography in the diagnosis and management of inflammatory bowel disease
Endoscopy
(1992)
Rectal wall thickness measured by ultrasound in chronic inflammatory diseases of the colon
Scan J Gastroenterol
Transrectal ultrasound in the diagnosis and management of inflammatory bowel disease
Endoscopy
Diagnosis of inflammatory bowel disease with ultrasound: an in vitro study
Invest Radiol
Cited by (40)
Ulcerative and Granulomatous Colitis: Idiopathic Inflammatory Bowel Disease
2014, Textbook of Gastrointestinal Radiology: Volumes 1-2, Fourth EditionEndoscopic ultrasound in pediatric patients
2013, Techniques in Gastrointestinal EndoscopyCitation Excerpt :EUS can also determine the length and extent of an ileocolonic stenosis in patients with Crohn's, thereby aiding clinicians to decide between endoscopic dilation and surgical stricturoplasty. It is actually thought that EUS can guide combined medical and surgical management of pediatric Crohn's disease; however, larger prospective studies are needed to determine whether there are improved outcomes using EUS as a guide [18,19]. EUS is also a valuable diagnostic tool in evaluating congenital anomalies of the GI tract.
Endoscopic Assessment of Inflammatory Bowel Disease: Colonoscopy/Esophagogastroduodenoscopy
2012, Gastroenterology Clinics of North AmericaCitation Excerpt :However, results seem to be disappointing. EUS has only been effective in the evaluation of perirectal and perianal complications of CD.42 For more information please refer to discussion elsewhere in this issue on examination under anesthesia, EUS, and MRI evaluation of perianal disease.
Operative Management of Crohn's Disease of the Colon Including Anorectal Disease
2007, Surgical Clinics of North AmericaCitation Excerpt :In the perianal area local septic processes and tenderness may require an examination under anesthesia to fully identify the extent of the disease. Endorectal ultrasound, CT, and MRI have also proven as useful radiologic adjuncts for the patient who has perianal disease to help diagnose and delineate fistula and abscesses [79,81,82]. Finally, patients presenting with perianal disease consistent with Crohn's disease should undergo a full alimentary tract evaluation with endoscopic and radiologic evaluation.
Ulcerative and Granulomatous Colitis: Idiopathic Inflammatory Bowel Disease
2007, Textbook of Gastrointestinal Radiology