Evaluation of deep remission with through-the-scope catheter-based EUS during double-balloon enteroscopy in small-bowel Crohn's disease.

BACKGROUND AND AIMS: Evaluation of deep remission in Crohn's disease (CD) can be challenging when the disease is confined to the small intestine. The aim of this study was to evaluate the effectiveness of through-the-scope EUS during double-balloon enteroscopy (DBE-EUS) in distinguishing small-bowel CD patients in endoscopic remission from those with active disease.

METHODS

Patients who underwent DBE-EUS were divided into groups of endoscopic remission and endoscopic activity according to segmental Simple Endoscopic Score for Crohn's Disease (SES-CD). The thickness of small intestinal wall layers and other parameters were evaluated by EUS.

RESULTS

EUS using an ultrasonic catheter probe by DBE showed that the total wall thickness (TWT) and submucosal thickness (SMT) of the small intestine in the active group were significantly greater than those in the remission group (3.84 ± 1.02 mm vs 2.42 ± .25 mm and 1.23 ± .34 mm vs .79 ± .13 mm, respectively; P < .001). Cutoff values of 2.65 mm for TWT and .95 mm for SMT can distinguish active small-bowel CD from inactive disease (sensitivity 91.5% and specificity 80.8% and sensitivity 70.2% and specificity 88.6%, respectively). The correlation analysis revealed a significant positive correlation between TWT and SES-CD (r =.930, P < .001). Furthermore, TWT was strongly correlated with fecal calprotectin (r = .861, P < .001) and Crohn's Disease Activity Index (r = .805, P < .001). Similar results were observed for SMT.

CONCLUSIONS

EUS using an ultrasonic catheter probe during DBE is effective in evaluation of both mucosal and transmural healing in small-bowel CD patients. DBE-EUS could become an important tool in the management of patients with small-bowel CD.