Endoscopic ultrasonography in the evaluation of condition and prognosis of ulcerative colitis

Abstract

Background: Ulcerative colitis (UC) is usually diagnosed through histopathology, enteroscopy, clinical symptoms, and physical findings; however, it is difficult to accurately evaluate disease severity.

Aim: To investigate the value of endoscopic ultrasonography (EUS) in the evaluation of the severity and prognosis of UC.

Methods: Patients with UC who were seen in our hospital from March 2019 to December 2020 were eligible, and disease severity was evaluated according to the modified Truelove and Witts and Mayo scores. We performed EUS, calculated the UC endoscopic index of severity (UCEIS) and EUS-UC scores, and administered appropriate treatment. The UCEIS and EUS-UC scores of patients were assessed in relation to disease severity, and the correlations between UCEIS and EUS-UC scores and disease severity was also analyzed. The UCEIS and EUS-UC scores before and after treatment were also compared.

Results: A total of 79 patients were included in this study. According to the Mayo Index, 23, 32, and 24 patients had mild, moderate and severe UC, respectively. The UCEIS and EUS-UC scores were higher in moderate cases (4.98 ± 1.04 and 5.01 ± 0.99, respectively) than in mild cases (1.56 ± 0.82 and 1.64 ± 0.91, respectively, P < 0.05). Furthermore, the UCEIS and EUS-UC scores (7.31 ± 1.10 and 7.59 ± 1.02, respectively) were higher in severe cases than in moderate cases (P < 0.05). According to the modified Truelove and Witts scores, 21, 36, and 22 patients were classified as having mild, moderate and severe disease, respectively. The UCEIS and EUS-UC scores were significantly higher in moderate disease (4.79 ± 1.11 and 4.96 ± 1.23, respectively) than in mild disease (1.71 ± 0.78 and 1.69 ± 0.88, respectively, P < 0.05). Additionally, the UCEIS and EUS-UC scores in severe disease (7.68 ± 1.22 and 7.81 ± 0.90, respectively) were significantly higher than in moderate disease (P < 0.05). The UCEIS and EUS-UC scores were significantly and positively correlated with disease severity according to the modified Truelove and Witts score and Mayo score (P < 0.05). The UCEIS and EUS-UC scores after 2 mo of treatment (3.88 ± 0.95 and 4.01 ± 1.14, respectively) and after 6 mo of treatment (1.59 ± 0.63 and 1.64 ± 0.59, respectively) were lower than the respective scores before treatment (5.93 ± 1.79 and 6.04 ± 2.01) (P < 0.05).

Conclusion: EUS can clarify the status of UC and accurately evaluate the treatment response, providing an objective basis for formulation and adjustment of the treatment plan.

Keywords: Disease severity; Endoscopic ultrasonography; Endoscopic ultrasonography-ulcerative colitis score; Mayo disease activity index; Prognosis; Ulcerative colitis; Ulcerative colitis endoscopic index of severity score.