Intestinal Ultrasound Is Accurate to Determine Endoscopic Response and Remission in Patients With Moderate to Severe Ulcerative Colitis: A Longitudinal Prospective Cohort Study

BACKGROUND & AIMS: Intestinal ultrasound (IUS) is noninvasive, cost-effective, and accurate to determine disease activity in ulcerative colitis (UC). In this study, we prospectively evaluated IUS for treatment response in a longitudinal cohort by using endoscopy and histology as gold standards. METHODS: Consecutive patients with moderate to severe UC (endoscopic Mayo score [EMS] similar to 2) starting tofacitinib treatment were included. Patients were evaluated at baseline and after 8 weeks of tofacitinib induction by means of clinical, biochemical, endoscopic (EMS and UC endoscopic index for severity), histologic (Robarts Histopathologic Index) and IUS assessments. Readers of IUS, endoscopy, and histology were blinded for all other outcomes. The primary outcome was difference in bowel wall thickness (BWT) for endoscopic improvement vs no endoscopic improvement. Endoscopic remission was defined as EMS = 0, improvement as EMS similar to 1, and response as a decrease of EMS similar to 1. RESULTS: Thirty patients were included, with 27 patients completing follow-up. BWT correlated with EMS (r = 0.68, P <.0001), UC endoscopic index for severity (r = 0.73, P <.0001) and Robarts Histopathologic Index (r = 0.49, P =.002) at both time points. BWT in the sigmoid was lower in patients with endoscopic remission (1.4 mm vs 4.0 mm, P =.016), endoscopic improvement (1.8 mm vs 4.5 mm, P <.0001) and decrease in BWT was more pronounced in patients with endoscopic response (similar to 58.1% vs similar to 13.4%, P =.018). The most accurate cutoff values for BWT were 2.8 mm (area under the curve [AUC] 0.87) for endoscopic remission, 3.9 mm (AUC 0.92) for improvement, and decrease of 32% (AUC 0.87) for response. The submucosa was the most responsive wall layer. CONCLUSION: IUS, importantly BWT as the single most important parameter, is highly accurate to detect treatment response when evaluated against endoscopic outcomes.