EARLY TRANSPERINEAL ULTRASONOGRAPHY AS A PREDICTOR OF HISTOLOGICAL REMISSION IN ULCERATIVE COLITIS FOLLOWING ADVANCED THERAPY

Introduction: Transperineal ultrasonography (TPUS) is suggested as a predictive tool for symptomatic improvement in ulcerative colitis (UC) by measuring rectal bowel wall thickness (BWT) changes. Its predictive value for various clinical outcomes warrants further exploration.

Aims & Methods: A post hoc analysis on the histologic-endoscopic outcomes based on post-treatment colonoscopy (> 14 weeks) was conducted on a prospective UC study where patients (1) underwent induction therapy with biologics or tofacitinib, and (2) had TPUS at baseline and week 1 to predict outcomes from BWT changes. The endpoint criteria—clinical, endoscopic, histological—are detailed in Table 1 A Geboes score <2.1 or a Nancy index ≤1 was used for histological remission. ROC curves were analyzed for each outcome.

Results: Of the 69 patients receiving advanced therapies including anti-TNF agents (N=26), vedolizumab (N=19), tofacitinib (N=14), and ustekinumab (N=10), 13-21.7% (N=9-15) achieved each outcome. The median interval for post-treatment endoscopy was 252 days (IQR 164-357). Week 1 ΔBWT most accurately predicted histological remission defined by a Nancy index ≤1, with an AUC of 0.80 (95% CI, 0.63-0.91). At a 0.5mm ΔBWT, the sensitivity was 83.3%, specificity 67.4%, PPV 40%, and NPV 93.9% (Table 1).

Conclusion: Early improvement in rectal BWT during the first week of induction therapy reliably predicts histological remission in UC following advanced therapies.

Keywords: bowel ultrasound; inflammatory bowel disease; predictor

Reference:
1. Sagami S, Kobayashi T, Aihara K, et al. Early improvement in bowel wall thickness on transperineal ultrasonography predicts treatment success in active ulcerative colitis. Alimentary pharmacology & therapeutics. 2022; 55 (10) :1320-1329