Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Assessment of perianal fistulizing Crohn’s disease activity with endoanal ultrasound: A retrospective cohort study
Na Hong, Wei-Yong Liu, Jin-Long Zhang, Kai Qian, Jie Liu, Xian-Jun Ye, Fei-Yan Zeng, Yue Yu, Kai-Guang Zhang
Na Hong, Yue Yu, Kai-Guang Zhang, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
Na Hong, Kai Qian, Jie Liu, Yue Yu, Kai-Guang Zhang, Department of Gastroenterology, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Na Hong, Wei-Yong Liu, Kai Qian, Jie Liu, Xian-Jun Ye, Fei-Yan Zeng, Yue Yu, Kai-Guang Zhang, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
Wei-Yong Liu, Xian-Jun Ye, Department of Ultrasound Medicine, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Jin-Long Zhang, Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Fei-Yan Zeng, Department of Radiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Co-first authors: Na Hong and Wei-Yong Liu.
Co-corresponding authors: Yue Yu and Kai-Guang Zhang.
Author contributions: Hong N collected and analysed data, drafted the article and diagnosed of CD patients; Liu WY interpreted data and performed Endoanal ultrasound; Zhang JL, Qiang K and Liu J assessed patients and analysed data preliminary; Ye XJ and Zeng FY performed Endoanal ultrasound and pelvic magnetic resonance imaging; Hong N, Yu Y and Zhang KG assessed of disease activity scores for all the patients; Yu Y and Zhang KG designed and reviewed the manuscript critically, and finally approved of the version to be published; all authors have read and approved the final manuscript.
Supported by the Major Project of Department of Education of Anhui Province of China, No. 2023AH040396.
Institutional review board statement: This single-center retrospective cohort study was approved by the Ethics Committee of the First Affiliated Hospital of University of Science and Technology of China (USTC, NO 2023-ky-248).
Informed consent statement: All the patients have voluntarily participated in the study and have signed informed consent forms.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data collected and generated from this study are available from the corresponding authors by reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Kai-Guang Zhang, PhD, Chief Physician, Department of Gastro
enterology, The First Affiliated Hospital of University of Science and Technology of China, No. 17 Lujiang Road, Hefei 230001, Anhui Province, China.
zhangkaiguang@ustc.edu.cn
Received: March 30, 2024
Revised: July 11, 2024
Accepted: July 18, 2024
Published online: August 27, 2024
Processing time: 138 Days and 23.9 Hours
BACKGROUND
Perianal fistulas pose dual challenges to Crohn's disease (CD) patients. Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.
AIM
To determine the accuracy of endoanal ultrasound (EUS) and shear wave elastography (SWE) for evaluating perianal fistulizing CD (PFCD) activity.
METHODS
This was a retrospective cohort study. A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups: Non-anal fistula group (n = 23), low-activity perianal fistulas [n = 19, perianal disease activity index (PDAI) ≤ 4], high-activity perianal fistulas (n = 25, PDAI > 4) based on the PDAI. All patients underwent assessments including EUS + SWE, pelvic magnetic resonance [pelvic magnetic resonance imaging (MRI)], C-reactive protein, fecal calprotectin, CD activity index, PDAI.
RESULTS
The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%, and there was good consistency in the classification of perianal fistulas (Kappa = 0.752, P < 0.001). Significant differences were observed in the blood flow Limberg score (χ2 = 8.903, P < 0.05) and shear wave velocity (t = 2.467, P < 0.05) between group 2 and 3. Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD (Magnifi-CD) score (r = -0.676, P < 0.001), a weak negative correlation with the PDAI score (r = -0.386, P < 0.05), and a weak correlation between the Limberg score and the PDAI score (r = 0.368, P < 0.05).
CONCLUSION
EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients. It may be the ideal tool to assess PFCD activity objectively for management strategies.
Core Tip: Perianal fistula in Crohn's disease (CD) is a poor prognostic phenotype with high recurrence. Given the frequent recurrence and need for reintervention, it is crucial to monitor the activity of perianal fistulas in patients with CD and provide appropriate clinical management. Our study found that shear wave velocity is highly accurate to evaluate perianal fistulizing CD (PFCD) activity based on the perianal disease activity index. It can be inferred that endoanal ultrasound + shear wave elastography may be the ideal tool to assess PFCD activity objectively for management strategies.
