The role of endoscopic ultrasound in inflammatory bowel disease

https://doi.org/10.1016/S1052-5157(02)00016-8Get rights and content

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

First page preview

First page preview
Click to open first page preview

References (27)

  • S.N. Rasmussen et al.

    Rectal wall thickness measured by ultrasound in chronic inflammatory diseases of the colon

    Scan J Gastroenterol

    (1985)
  • U. Dağli et al.

    Transrectal ultrasound in the diagnosis and management of inflammatory bowel disease

    Endoscopy

    (1999)
  • M.B. Kimmey et al.

    Diagnosis of inflammatory bowel disease with ultrasound: an in vitro study

    Invest Radiol

    (1990)
  • Cited by (40)

    • Ulcerative and Granulomatous Colitis: Idiopathic Inflammatory Bowel Disease

      2014, Textbook of Gastrointestinal Radiology: Volumes 1-2, Fourth Edition
    • Endoscopic ultrasound in pediatric patients

      2013, Techniques in Gastrointestinal Endoscopy
      Citation 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 America
      Citation 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 America
      Citation 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.

    View all citing articles on Scopus
    View full text