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Intestinal Ultrasound for Appendiceal Assessments in Patients With Ulcerative Colitis

David H. Bruining, MD, FASGE reviewing Reijntjes MA, et al. Aliment Pharmacol Ther 2022 Nov 1.

Ongoing studies seek to address whether appendectomy is an efficacious treatment option for appendiceal inflammation in patients with ulcerative colitis (UC). Intestinal ultrasound (IUS) has emerged as a noninvasive, well-tolerated imaging modality in patients with inflammatory bowel disease, but little has been reported on the performance of IUS for UC appendiceal assessments.

Researchers performed a prospective cohort study in patients with active UC (A-UC; n=35) or quiescent UC (Q-UC; n=30) and in healthy controls (HC; n=30). The benchmarks for A-UC were a Simple Clinical Colitis Activity Index (SCCAI) >5 and a fecal calprotectin (FC) level ≥250 µg/g within 4 weeks of IUS. The criteria for Q-UC included an SCCAI ≤5 and FC ≤150 µg/g. 

The appendix could be adequately visualized in approximately 60% of individuals. Compared with healthy controls, patients with UC had a higher transverse appendiceal diameter (TAD) and submucosal thickness (P≤.01). The differences in these imaging parameters were not statistically significant between the A-UC and Q-UC groups. A TAD ≥6 mm was predominantly noted in the patients with A-UC (A-UC: 43%, Q-UC: 6%, and HC: 0%; P=.01) and was not impacted by disease extent.


Comment:

This important study highlights the potential role of IUS in identifying appendiceal inflammation in patients with UC. These findings could be of immense importance if future trials identify subsets of patients who may benefit from appendectomy as a primary IBD treatment strategy.

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David H. Bruining, MD, FASGE

Bio and Disclosures

Citation(s):

Reijntjes MA, de Voogd FAE, Bemelman WA, et al. Intestinal ultrasound detects an increased diameter and submucosal layer thickness in the appendix of patients with ulcerative colitis compared to healthy controls - a prospective cohort study. Aliment Pharmacol Ther 2022 Nov 1. (Epub ahead of print) (https://doi.org/10.1111/apt.17267)