F de Voogd1,2, S Bots1, K Gecse1, O H Gilja3,4, G D'Haens1, K Nylund3,4. 1. Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands. 2. Amsterdam Gastroenterology Endocrinology Metabolism Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 3. National Centre of Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway. 4. Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Abstract
BACKGROUND: To assess treatment response, objective measures are superior to clinical improvement in Crohn's Disease (CD). Intestinal ultrasound (IUS) is an attractive, non-invasive alternative to endoscopy demonstrating early transmural changes after treatment initiation. Therefore, we investigated IUS and contrast-enhanced ultrasound (CEUS) to predict (early) endoscopic treatment response. METHODS: Consecutive patients with endoscopically active CD starting anti-TNFα therapy were included. Clinical, biochemical, IUS and CEUS parameters at baseline (T0), after 4-8 weeks (T1) and 12-34 weeks (T2) were collected. The most severely inflamed segment at endoscopy (highest segmental SES-CD) and IUS (highest segmental bowel wall thickness (BWT)) was identified. At T2, endoscopic response (decrease SES-CD≥50%) and remission (SES-CD=0) were scored. RESULTS: 40 patients were included, 14 reached endoscopic remission and 17 endoscopic response. At T1 (3.1 mm [1.9-4.2] vs 5.3 mm [3.8-6.9], p=0.005) and T2 (2.0 mm [1.8-3.1] vs 5.1 [3.0-6.3] mm, p=0.002) BWT was lower in patients with endoscopic remission. At T1 and T2, 18% (AUROC: 0.77; OR: 10.80, p=0.012) and 29% (AUROC: 0.833; OR: 37.50, p=0.006) BWT decrease predicted endoscopic response, respectively. 3.2 mm was most accurate to determine endoscopic remission (AUROC: 0.94; OR: 39.42, p<0.0001) at T2. In addition, absence of Colour Doppler Signal (OR: 13.76, p=0.03) and the CEUS parameter Wash-out Rate (OR: 0.76, p=0.019) improved the prediction model. CONCLUSION: Reduction in BWT, already after 4-8 weeks of follow-up, predicted endoscopic response and remission. CEUS parameters were of limited value. Furthermore, we have provided accurate cut-offs for BWT reflecting endoscopic response and remission at different time points.
BACKGROUND: To assess treatment response, objective measures are superior to clinical improvement in Crohn's Disease (CD). Intestinal ultrasound (IUS) is an attractive, non-invasive alternative to endoscopy demonstrating early transmural changes after treatment initiation. Therefore, we investigated IUS and contrast-enhanced ultrasound (CEUS) to predict (early) endoscopic treatment response. METHODS: Consecutive patients with endoscopically active CD starting anti-TNFα therapy were included. Clinical, biochemical, IUS and CEUS parameters at baseline (T0), after 4-8 weeks (T1) and 12-34 weeks (T2) were collected. The most severely inflamed segment at endoscopy (highest segmental SES-CD) and IUS (highest segmental bowel wall thickness (BWT)) was identified. At T2, endoscopic response (decrease SES-CD≥50%) and remission (SES-CD=0) were scored. RESULTS: 40 patients were included, 14 reached endoscopic remission and 17 endoscopic response. At T1 (3.1 mm [1.9-4.2] vs 5.3 mm [3.8-6.9], p=0.005) and T2 (2.0 mm [1.8-3.1] vs 5.1 [3.0-6.3] mm, p=0.002) BWT was lower in patients with endoscopic remission. At T1 and T2, 18% (AUROC: 0.77; OR: 10.80, p=0.012) and 29% (AUROC: 0.833; OR: 37.50, p=0.006) BWT decrease predicted endoscopic response, respectively. 3.2 mm was most accurate to determine endoscopic remission (AUROC: 0.94; OR: 39.42, p<0.0001) at T2. In addition, absence of Colour Doppler Signal (OR: 13.76, p=0.03) and the CEUS parameter Wash-out Rate (OR: 0.76, p=0.019) improved the prediction model. CONCLUSION: Reduction in BWT, already after 4-8 weeks of follow-up, predicted endoscopic response and remission. CEUS parameters were of limited value. Furthermore, we have provided accurate cut-offs for BWT reflecting endoscopic response and remission at different time points.
Authors: Pierluigi Puca; Livio Enrico Del Vecchio; Maria Elena Ainora; Antonio Gasbarrini; Franco Scaldaferri; Maria Assunta Zocco Journal: Diagnostics (Basel) Date: 2022-08-17