Background and Aim Though colonoscopy plays a crucial role in assessing active ulcerative colitis (aUC), its scope is limited to the mucosal surface. Endoscopic ultrasound (EUS) coupled with contrast-enhancement (dCEUS) can precisely quantify bowel wall thickness and microvascular circulation, potentially enabling the quantitative evaluation of inflammation. We conducted a prospective, longitudinal study to assess therapy response using dCEUS in aUC patients undergoing treatment with adalimumab (ADA) or infliximab (IFX). Methods 30 ADA- and 15 IFX-treated aUC patients were examined at baseline and at 2, 6, 14 weeks of therapy and 48 weeks of follow-up. Bowel wall thickness (BWT) was measured by EUS in the rectum. Vascularity was quantified by dCEUS using Rise Time (RT) and Time To Peak (TTP). Therapy response was defined after 14 weeks using the Mayo Score. Results Patients with aUC displayed a mean BWT of 3.9±0.9 mm. In case of response to ADA/IFX a significant reduction in BWT was observed after 2 weeks (p=0.04), whereas non-responders displayed no significant changes. The TTP was notably accelerated at baseline and significantly normalised by week 2 in responders (p=0.001), while non-responders exhibited no significant alterations (p=0.9). At week 2, the endoscopic Mayo score did not exhibit any changes, thus failing to predict treatment responses. Conclusion dCEUS enables the early detection of therapy response in patients with aUC, which serves as a predictive marker for long term clinical success. Therefore, dCEUS serves as a diagnostic tool for assessing the probability of future therapy success.

中文翻译：

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对比增强内窥镜超声检测溃疡性结肠炎患者抗 TNF 治疗后的早期治疗反应

背景和目的 虽然结肠镜检查在评估活动性溃疡性结肠炎 (aUC) 方面发挥着至关重要的作用，但其范围仅限于粘膜表面。超声内镜 (EUS) 与对比增强 (dCEUS) 相结合可以精确量化肠壁厚度和微血管循环，从而有可能实现炎症的定量评估。我们进行了一项前瞻性纵向研究，以评估接受阿达木单抗 (ADA) 或英夫利昔单抗 (IFX) 治疗的 aUC 患者使用 dCEUS 的治疗反应。方法 对 30 名 ADA 和 15 名 IFX 治疗的 aUC 患者进行基线检查以及治疗 2、6、14 周和 48 周随访时的检查。肠壁厚度 (BWT) 通过 EUS 在直肠中测量。通过 dCEUS 使用上升时间 (RT) 和达到峰值时间 (TTP) 对血管进行量化。14 周后使用 Mayo 评分定义治疗反应。结果 aUC 患者的平均 BWT 为 3.9±0.9 mm。如果对 ADA/IFX 有反应，两周后观察到 BWT 显着降低 (p=0.04)，而无反应者则没有表现出显着变化。应答者的 TTP 在基线时显着加速，并在第 2 周显着正常化 (p=0.001)，而无应答者则没有表现出显着变化 (p=0.9)。第 2 周时，内镜 Mayo 评分没有表现出任何变化，因此无法预测治疗反应。结论 dCEUS 能够早期检测 aUC 患者的治疗反应，作为长期临床成功的预测标志。因此，dCEUS 可作为评估未来治疗成功概率的诊断工具。