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Poster presentations: Clinical: Diagnosis and Outcome 2020

P189 Use of transabdominal ultrasonography for the evaluation of Crohn’s disease activity

E. Yorulmaz1, B. Yigit2, M.S. Erturk3, U. Erdem3, U. Yanc3, H. Yorulmaz4, G. Bilik Oyman5, O. Sezgin6

1Bagcilar Education and Research Hospital, Gastroenterology, Istanbul, Turkey, 2Bagcilar Education and Research Hospital, Internal Medicine, Istanbul, Turkey, 3Sisli Education and Research Hospital, Radiology, Istanbul, Turkey, 4School of Nursing, Halic University, Istanbul, Turkey, 5Okmeydani Education and Research Hospital, Internal Medicine, Istanbul, Turkey, 6Faculty of Medicine, Gastroenterology, Mersin University, Istanbul, Turkey

Background

Ileocolonoscopy is accepted as the gold standard method for the diagnosis of Crohn’s disease (CD). However, there are cases where it is inadequate due to being invasive, failure to allow endoscopic exploration of the small intestine, and failure to show the extraintestinal pathologies. In the present study, it is aimed to compare clinical, endoscopic scores and computerised tomography enterography (CTE) findings with transabdominal ultrasonography (TAUS) findings in order to evaluate the activity of CD.

Methods

The study included 79 patients diagnosed with CD. Crohn’s Disease Activity Index (CDAI) and Harvey Bradshaw Index (HBI) were used for the evaluation of the clinical activities of the patients. The patients with CDAI equal to 150 and more and HBI equal to 5 points and more were assessed as clinically active. Colonoscopic disease activity was assessed by The Simple Endoscopic Score for Crohn’ disease (SES-CD), SES-CD score of 3 and higher was defined as endoscopically active. In the evaluation of CTE and TAUS, the measurement of the thickness of the intestinal wall above 3 mm was accepted as pathological. Abscess, mass, fistula and ileus were evaluated as complications. Superior mesenteric artery (SMA) flow velocity was assessed by Color Doppler US. Limberg score was graded from Grades 0 to 4 for Doppler TAUS.

Results

Of the patients, 57 (72.1%) were male and 22 (27.8%) were female. Age average of the patients was 37.5 years (17–64) and the mean duration of disease was 48.6 months (0–240 months). Increase in the wall thickness in CTE and TAUS, detection of inflammation and complication in mesenteric fatty planes were found to be highly significant (p ˂ 0.0001). Wall thickness increase sensitivity level of TAUS according to CTE was 82%, specificity level was 97%, sensitivity level of the inflammation finding in mesenteric fatty planes was measured as 80%, and specificity level as 95%. A significant correlation was found between the wall thickness increase in CTE and TAUS and inflammation in mesenteric fatty planes via CDAI, HBI and SES-CD scoring (p ˂ 0.05). In addition, there was a significant relationship between the presence of lymphadenopathy in CTE in active patients according to HBI (p ˂ 0.05). According to the CDAI and SES-CD scores, Doppler flow velocity of SMA was significantly higher in the active group than the inactive group (p ˂ 0.05). CDAI, HBI and SES-CD results were found highly significant via the Limberg Scoring results (p < 0.0001).

Conclusion

In the current study, it is shown that TAUS is a diagnostic tool as effective as CTE in the evaluation of CD activity. In addition, it is an important finding that the flow velocity of SMA increases as correlated with inflammation via the Doppler feature of TAUS.