OBJECTIVES:Transcutaneous bowel sonography is a nonionizing imaging modality used in inflammatory bowel disease. Although available in Europe, its uptake in North America has been limited. Since the accuracy of bowel sonography is highly operator dependent, low-volume centers in North America may not achieve the same diagnostic accuracy reported in the European literature. Our objective was to determine the diagnostic accuracy of bowel sonography in a nonexpert low-volume center. METHODS:All cases of bowel sonography at a single tertiary care center during an 18-month period were reviewed. Bowel sonography was compared with reference standards, including small-bowel follow-through, computed tomography, magnetic resonance imaging, colonoscopy, and surgical findings. RESULTS:A total of 103 cases were included for analysis during the study period. The final diagnoses included Crohn disease (72), ulcerative colitis (8), hemolytic uremic syndrome (1), and normal (22). The sensitivity and specificity of bowel sonography for intestinal wall inflammation were 87.8% and 92.6%, respectively. In the subset of patients who had complications of Crohn disease, the sensitivity and specificity were 50% and 100% for fistulas and 14% and 100% for strictures. One patient had an abscess, which was detected by bowel sonography. Abnormal bowel sonographic findings contributed to the escalation of treatment in 55% of cases. CONCLUSIONS:Bowel sonography for inflammatory bowel disease can be performed in low-volume centers and provides diagnostic accuracy for luminal disease comparable with published data, although it is less sensitive for complications of Crohn disease.

译文

目的:经皮肠超声检查是一种用于炎症性肠病的非电离成像方式。尽管在欧洲有售,但其在北美的使用受到限制。由于肠超声检查的准确性在很大程度上取决于操作员,因此北美的小容量医疗中心可能无法达到欧洲文献中报告的诊断准确性。我们的目标是确定非专业小剂量中心的肠超声检查的诊断准确性。
方法:回顾了18个月内在一家三级护理中心进行肠超声检查的所有病例。将肠超声检查与参考标准进行比较,包括小肠随访,计算机断层扫描,磁共振成像,结肠镜检查和手术结果。
结果:在研究期间共纳入103例病例进行分析。最终诊断包括克罗恩病(72),溃疡性结肠炎(8),溶血性尿毒症综合征(1)和正常(22)。肠超声检查对肠壁炎症的敏感性和特异性分别为87.8%和92.6%。在患有克罗恩病并发症的患者子集中,对瘘管的敏感性和特异性分别为50%和100%,对于狭窄则分别为14%和100%。一名患者脓肿,经肠超声检查发现。肠超声检查结果异常有助于55%的病例升级。
结论:炎症性肠病的肠镜检查可以在小容量的中心进行,尽管对克罗恩病的并发症敏感性较低,但可以提供与已发表的数据相媲美的腔内疾病的诊断准确性。

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