Endoscopic Ultrasound

EUS is a procedure for imaging the intestinal wall at high resolution. The use of EUS shows findings that distinguish normal colon from IBD as increased wall thickness, lymphadenopathy or enlarged perirectal vessels [33]. In particular, vessel enlargement is more likely associated with patients with acute Crohn's disease whereas adenopathy is associated with acute UC. Therefore, this procedure could be helpful in differentiating the two diseases. An alternative to EUS is the high-frequency ultrasound catheter probe. In one study, a 20-MHz radial catheter was used to evaluate the colorectal wall in patients with IBD [34]. Crohn's disease was associated with thickening of the fourth hypoechoic layer (muscularis propria) or loss of layer structure, and mucosal and submucosal thickening was more likely in ulcerative disease.

Moreover, EUS plays a major role in diagnosis and assessment of Crohn's anorectal and perineal complications, such as abscesses or fistulae. Barium fistu-lography and computed tomography (CT) of the pelvis have been less sensitive for perianal disease [35] than EUS of the rectum [36]. One study demonstrated that rectal EUS had a diagnostic accuracy of at least 85%, as with examination under anesthesia and pelvic MRI, when evaluating the anatomy of perianal fistulae [37]. When any two tests were combined, the accuracy was 100%.

Finally, endoscopic-ultrasound-guided fine-needle aspiration may help confirm the diagnosis for suspected abscesses and provide therapeutic procedures [38].

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