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Ratio of submucosal thickness to total bowel wall thickness as a new sonographic parameter to estimate endoscopic remission of ulcerative colitis

  • Original Article—Alimentary Tract
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Abstract

Background

The development of feasible, reliable parameters and criteria for intestinal ultrasound (IUS) to estimate endoscopic remission of ulcerative colitis (UC) is a crucial clinical challenge. Such parameters must be simple, objective, and reproducible so that IUS can be widely used in daily practice. We developed a new parameter called the submucosa index (SMI), defined as a percentage of the submucosal thickness (SMT) in the total bowel wall thickness (BWT), and investigated its clinical potential.

Methods

The inclusion criteria were performance of both IUS and endoscopy (sigmoidoscopy or colonoscopy) for UC and a ≤ 15-day time interval between IUS and endoscopy. Loss of stratification was defined as inability to identify the submucosa even with a BWT of > 3 mm. The vascularity of the colon was assessed by the modified Limberg score (mLS) and evaluated as bowel wall flow (BWF) ( −) or ( +) using color Doppler mode. A Mayo endoscopic subscore (MES) of 0 or 1 was defined as endoscopic remission.

Results

Seventy-four colonic segments were analyzed. The SMI, mLS, and BWF could distinguish an MES of 1 versus 2 (p < 0.05, p < 0.01, and adjusted p < 0.001, respectively). The criteria using the BWT and SMI and using the BWT and BWF had the same estimating ability for endoscopic remission (sensitivity, 70.0%; specificity, 97.7%; positive predictive value, 95.5%; and negative predictive value, 82.7%).

Conclusion

The SMI is a practical, quantitative parameter based on the bowel wall structure and may be used to estimate endoscopic remission of UC.

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References

  1. Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: an update on the selecting therapeutic targets in inflammatory bowel disease (STRIDE) initiative of the international organization for the study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD. Gastroenterology. 2021;160:1570–83.

    Article  CAS  Google Scholar 

  2. Neurath MF, Travis SP. Mucosal healing in inflammatory bowel diseases: a systematic review. Gut. 2012;61:1619–35.

    Article  CAS  Google Scholar 

  3. Goodsall TM, Nguyen TM, Parker CE, et al. Systematic review: gastrointestinal ultrasound scoring indices for inflammatory bowel disease. J Crohns Colitis. 2021;15:125–42.

    Article  Google Scholar 

  4. Bots S, Nylund K, Lowenberg M, et al. Intestinal ultrasound to assess disease activity in ulcerative colitis: development of a novel UC-ultrasound index. J Crohns Colitis. 2021;15:1264–71.

    Article  Google Scholar 

  5. Limberg B, Osswald B. Diagnosis and differential diagnosis of ulcerative colitis and Crohn’s disease by hydrocolonic sonography. Am J Gastroenterol. 1994;89:1051–7.

    CAS  PubMed  Google Scholar 

  6. Stewart SF. Effects of transducer, velocity, Doppler angle, and instrument settings on the accuracy of color Doppler ultrasound. Ultrasound Med Biol. 2001;27:551–64.

    Article  CAS  Google Scholar 

  7. Kruskal JB, Newman PA, Sammons LG, et al. Optimizing Doppler and color flow US: application to hepatic sonography. Radiographics. 2004;24:657–75.

    Article  Google Scholar 

  8. Nakase H, Uchino M, Shinzaki S, et al. Evidence-based clinical practice guidelines for inflammatory bowel disease 2020. J Gastroenterol. 2021;56:489–526.

    Article  Google Scholar 

  9. Sagami S, Kobayashi T, Miyatani Y, et al. Accuracy of ultrasound for evaluation of colorectal segments in patients with inflammatory bowel diseases: a systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2021;19:908-921.e6.

    Article  Google Scholar 

  10. De Voogd F, Wilkens R, Gecse K, et al. A reliability study: strong inter-observer agreement of an expert panel for intestinal ultrasound in ulcerative colitis. J Crohns Colitis. 2021;15:1284–90.

    Article  Google Scholar 

  11. Maaser C, Petersen F, Helwig U, et al. Intestinal ultrasound for monitoring therapeutic response in patients with ulcerative colitis: results from the TRUST&UC study. Gut. 2020;69:1629–36.

    Article  Google Scholar 

  12. Vuitton L, Peyrin-Biroulet L, Colombel JF, et al. Defining endoscopic response and remission in ulcerative colitis clinical trials: an international consensus. Aliment Pharmacol Ther. 2017;45:801–13.

    Article  CAS  Google Scholar 

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Acknowledgements

This work was supported in part by grants from the Japan Sciences Research Grant for Research on Intractable Diseases (Japanese Inflammatory Bowel Disease Research Group) affiliated with the Japan Ministry of Health, Labour and Welfare. We thank Angela Morben, DVM, ELS, from Edanz (https://jp.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka-shi, Tokyo, 181-8611, Japan

    Jun Miyoshi, Ryo Ozaki, Hiromi Yonezawa, Hideaki Mori, Naohiro Kawamura, Minoru Matsuura & Tadakazu Hisamatsu

Authors
  1. Jun Miyoshi
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  2. Ryo Ozaki
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  3. Hiromi Yonezawa
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  4. Hideaki Mori
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  5. Naohiro Kawamura
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  6. Minoru Matsuura
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  7. Tadakazu Hisamatsu
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Contributions

JM, RO, and HY conceived the study, designed the experiments, and analyzed the data. JM, RO, HY, HM, and NK prepared the manuscript. MM and TH supervised the writing of the manuscript. TH oversaw the entire project.

Corresponding author

Correspondence to Tadakazu Hisamatsu.

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Conflict of interest

Minoru Matsuura received consulting and lecture fees from Janssen Pharmaceutical K.K.; and received a scholarship grant from Nippon Kayaku Co., Ltd. Tadakazu Hisamatsu received consulting and lecture fees from Mitsubishi Tanabe Pharma Corporation, AbbVie GK, EA pharma Co., Ltd., Kyorin Pharmaceutical Co., Ltd., JIMRO Co., Ltd., Janssen Pharmaceutical K.K., Mochida Pharmaceutical Co., Ltd., and Takeda Pharmaceutical Co., Ltd.; and received research grants from Alfresa Pharma Co., Ltd., EA pharma Co., Ltd., Mitsubishi Tanabe Pharma Corporation, AbbVie GK, JIMRO Co., Ltd., Zeria Pharmaceutical Co., Ltd., Daiichi-Sankyo, Kyorin Pharmaceutical Co., Ltd., Nippon Kayaku Co., Ltd., Astellas Pharma Inc., Takeda Pharmaceutical Co., Ltd., Pfizer Inc., and Mochida Pharmaceutical Co., Ltd. Jun Miyoshi, Ryo Ozaki, Hiromi Yonezawa, Hideaki Mori, and Naohiro Kawamura have no conflict of interest.

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Miyoshi, J., Ozaki, R., Yonezawa, H. et al. Ratio of submucosal thickness to total bowel wall thickness as a new sonographic parameter to estimate endoscopic remission of ulcerative colitis. J Gastroenterol 57, 82–89 (2022). https://doi.org/10.1007/s00535-021-01847-3

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  • DOI: https://doi.org/10.1007/s00535-021-01847-3

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