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HIGH RESOLUTION ABDOMINAL ULTRASONOGRAPHY IN CROHN’S DISEASE: DEGREE OF CORRELATION WITH ENDOSCOPIC FINDINGS AT THE TERMINAL ILEUM
G Chami, S Wilson, GG Kaplan, SM Devlin, J Jones, R Panaccione
Inflammatory Bowel Disease Clinic, University of Calgary, Calgary, Alberta
INTRODUCTION: Ileocolonoscopy is the gold standard in assessing ileal Crohn’s disease (CD). However, colonoscopy is associated with procedural risks, risks of conscious sedation as well as significant direct and indirect costs. High-resolution ultrasonography (HRUS) is a widely accessible, economical, and safe method of assessing intra-abdominal pathology; however, its exact role in assessing ileal CD activity remains unclear. Our aims were to evaluate the role of HRUS and to assess the degree of agreement between HRUS and ileocolonoscopy of the terminal ileum in patients with CD.
METHODS: All patients who underwent HRUS for CD at the Foothills Medical Centre between June 2007 and October 2007 were retrospectively identified by chart review. Ultrasound characteristics considered were; bowel wall thickening > 4mm, hyperemia, inflammatory fat, and mesenteric lymphadenopathy. Patient demographics, indication for HRUS, disease extent and the reported findings at the terminal ileum were recorded. A subset of patients who also underwent an ileocolonoscopy within 3 months of the HRUS was identified. Terminal ileal findings at ileocolonoscopy were compared to those at HRUS for percent agreement.
RESULTS: Fifty-three CD patients underwent HRUS. The median age was 35 years (interquartile range, 26 to 44) and 56.6% were female. 13 patients (24.5%) had isolated ileal disease; 7 (13.2%) had isolated colonic disease; and 33 (62.3%) had ileocolonic disease. HRUS was ordered to evaluate extent and severity of symptomatic ileitis in 34 patients (64.1%) and to assess asymptomatic individuals with suspected ileitis in 19 patients (35.9%). HRUS identified terminal ileitis in 34 patients (64.1%). Fifteen patients (28.3%) underwent an ileocolonoscopy within three months of HRUS. HRUS findings at the terminal ileum agreed with colonoscopic findings in 9 (60%) studies. Both studies reported ileitis in 6 patients and normal ileum in 3. In 2 patients HRUS reported ileitis that was not present on ileocolonoscopy, whereas 4 HRUS studies were read as normal when aphthous ulcerations were observed during ileocolonoscopy.
CONCLUSION: HRUS may have a role in evaluating moderate to severe Crohn’s disease at the terminal ileum; however, prospective studies will be needed to define its sensitivity and specificity.