1. Internist, Tehran University of Medical Sciences 2. Department of internal medicine, division of Gastroenterology, Imam Khomeini Hospital, Tehran University of Medical Scie 3. Department of internal medicine, division of Gastroenterology, Tehran University of Medical Sciences
Abstract
Introduction
The differentiation between ulcerative colitis (uc) and crohn’s disease (cd) is an important issue for choosing the appropriate treatment. endoscopic ultrasonography (eus) has been used to distinguish different layers of the gastrointestinal wall. we performed this study to evaluate the accuracy of eus in differentiating uc from cd in colon
Methods
This is a prospective, single blinded diagnostic accuracy study, on 70 patients (30 uc, 30 cd and 10 healthy controls). after obtaining informed consent, patients underwent a complete work up and were referred to an endosonographist who was blind to the diagnosis. thickness of mucosa, submucosa and total wall (twt) of mid sigmoid colon were measured
Results
Our study revealed sensitivity of 100% and specificity of 92.3% for eus to differentiate uc and cd comparing to standard diagnostic tests. mean mucosal thickness in patients with uc was significantly greater than patients with cd, while, mean sub-mucosal thickness was significantly greater in patients with cd (p<0.001). the sensitivity and specificity of mean mucosal thickness for differentiating uc form cd and controls were 92.3% and 88.6% with cut-off point of 1.1 mm (p<0.001). moreover, sensitivity and specificity of mean submucosal thickness for differentiating cd from uc and controls were 100% and 86.1% with cut-off point of 1.08 mm (p<001)
Conclusion
Eus can be used as an efficient modality with acceptable accuracy to differentiate crohn’s disease and ulcerative colitis. it helps especially in patients with indeterminate colitis to correctly select medical and surgical treatments
