Value Of Colonoscopy,Endoscopic Ultrasonography And Computed Tomographic Enterography In The Diagnosis Of Inflammatory Bowel Disease

Objective: To explore the value of colonoscopy, endoscopic ultrasonography(endoscopic ultrasonography, EUS) and computed tomographic enterography(computed tomographic enterography, CTE) in diagnosis and activity assessment of inflammatory bowel disease( inflammatory bowel diseases,IBD),and guide the clinical diagnosis and treatment.Methods: The colonoscopy, EUS and CTE examinations of 105 patients(68 ulcerative colitis,37 crohn’s disease) with IBD diagnosed by endoscopy, CT, MRI and pathology in the First Affiliated Hospital of Kunming Medical University between September 2014 and September 2016 were analyzed retrospectively,the imaging manifestations, detecting rates and value to evaluate the disease activity were compared among three examinations.Results:1. The bowel lesions can be directly observed by colonoscopy, and disease activity could be predicted using modified Baron scale and simple endoscopic score for Crohn’ s disease(simple endoscopic score for Crohn’s disease, SES-CD);2. EUS can observe not only the digestive tract mucosa lesions but also the digestive tract wall and pipe wall outside, moreover by measuring the wall thickness to assess disease severity of UC: the total wall thickness of mild, moderate and heavy UC patients were 3.59 ± 0.69mm(Mean ± Standard Deviation)、4.54 ± 0.96mm and 5.99± 1.16mm,respectively. Mucosal thickness were 1.02 ± 0.14mm(Mean ± Standard Deviation).1.22±0.25mm and 1.61 ±0.27mm. Submucosa thickness were 1.41 ±0.36mm(Mean ± Standard Deviation)、2.07 ± 0.70mm and 2.67 ± 0.51mm. The differences were statistically significant;3. The present study detected 9 patients (30.00%)with small intestinal lesions. CTE observation had obvious advantages in detection of CD patients with small intestinal lesions over colonoscopy;4. In UC group, the detection rates of lesions in colonoscopy, EUS, CTE were86.76%、77.94% and 71.43%,respectively;The combined detection rate of colonoscopy and CTE was92.86%, colonoscopy +CTE+EUS was92.86%, which were higher than that of single CTE (χ 2 4.383, P = 0.036). In CD group, the detection rate of lesions in separate examination of colonoscopy, EUS, CTE were 62.16%, 86.49%,and 76.67%; The following positive rates were significantly higher than singlecolonoscopy examination: EUS was 86.49% ( χ2 =5.736,P=0.017),colonoscopy combined EUS was 89.19% ( χ2=7.341, P=0.007) , colonoscopy combined CTE was 90.00%’ (χ2 =6.780,P=0.009),colonoscopy+CTE+EUS was93.33% (x =8.856,P=0.003);5. The predictive value in disease activity in UC groupfrom high to lowwas as follows:modifiedBaron scale ( r=0.748,P<0.001 ) , mucosal thickness by EUS(r=0.671,P<0.001 ),total wall thicknessby EUS(r = 0.720, P < 0.720),submucosa thickness by EUS wall thickness (r = 0.681, P < 0.001),submucosa thickness byEUS(r=0.628,P<0.001 ) ;In CD group, SES-CD score can predict disease activity (r =0.656, P< 0.001).Conclusions:1. Colonoscopy can directly observe the bowel lesions and predict disease activity with modified Baron scale, SES - CD score;2. EUS can evaluate UC activity by measuring bowel wall thickness;3. CTE observation has obvious advantages in CD patients with small intestinal lesions;4. Combination of colonoscopy, EUS and CTE can significantly improve the lesion detection rate in the diagnosis of IBD.5. Clinical manifestations should be closely combined with colonoscopy, EUS and CTE in the diagnosis and treatment of IBD, which is beneficial for predicting the severity of disease and choosing the best treatment plan.