Role of Intestinal Ultrasound versus Ileocolonoscopy in Early detection of Clinically Suspected Inflammatory Bowel Disease

Abstract

Background: Inflammatory bowel disease (IBD) necessitates prompt and precise diagnosis to enhance outcomes. Ileocolonoscopy with histopathology is the best diagnostic method. However, it is invasive and takes a lot of resources. Intestinal ultrasound (IUS) has developed as a non-invasive option; however, its efficacy in newly suspected IBD necessitates further investigations. Thus, this study aimed to assess the diagnostic efficacy of IUS relative to ileocolonoscopy and histopathology for the early identification of clinically suspected IBD.

Patients and Methods: This study comprised 82 patients (≥16 years) exhibiting symptoms indicative of IBD. All underwent comprehensive history taking, clinical examination, laboratory evaluation (e.g., CRP, ESR, and fecal calprotectin), ultrasound imaging, ileocolonoscopy, and mucosal biopsy. We figured out the diagnostic accuracy indices and looked at how they were related to endoscopic severity scores (Mayo for UC and SES-CD for CD).

Results: Most patients aged 21–40 years (70.8%), with a nearly equal distribution of sexes (51.2% males). Chronic abdominal pain (63.4%) and diarrhea (51.2%) were the most common symptoms. Inflammatory markers were higher in IBD than non-IBD. IUS was positive in 62.2% of patients, with bowel wall thickening (59.8%), loss of stratification (46.3%), and hyperechoic perienteric fat (43.9%) as the main results. The positivity of IUS rose significantly with endoscopic severity in both ulcerative colitis (p = 0.002) and Crohn's disease (p = 0.012). IUS had 83.6% sensitivity, 81.5% specificity, and 82.9% accuracy when compared to colonoscopy. IUS had 88.5% sensitivity, 83.3% specificity, and 86.6% accuracy compared to histopathology. Colonoscopy had 100% sensitivity, 90.0% specificity, and 96.3% accuracy. 

Conclusion: Intestinal ultrasound exhibits an accepted diagnostic accuracy and a robust correlation with endoscopic and histological results in newly suspected inflammatory bowel disease (IBD). IUS could be considered as a reliable, non-invasive first-line screening tool.