The role of endoscopic ultrasound in inflammatory bowel disease

Ultrasonography has been applied to the diagnosis and management of inflammatory bowel disease for over 20 years. The combination of endoscopy with ultrasound has resulted in the application of intraluminal sonographic imaging to multiple diseases, including inflammatory bowel disease. Initial efforts were focused on the sonographic assessment of disease severity as based on bowel wall thickness, but this has been inconsistently demonstrated. Furthermore, disease severity is a clinical assessment that is based on both clinical and imaging studies. Recognizing that Crohn's disease tends to be transmural and ulcerative colitis a superficial mucosal inflammatory process, hopes were raised that endosonography would be effective in discriminating cases of otherwise indeterminate colitis. Efforts to demonstrate this, however, have been largely disappointing, and EUS plays a limited role in discriminating ulcerative colitis from Crohn's disease. On a more positive note, EUS evaluation of perirectal and perianal complications of Crohn's disease has been demonstrated to be superior to fistulography, CT, and equal to or superior to MRI. Because accurate anatomic information is required to guide surgical therapy of these lesions, EUS has the potential to emerge as a powerful imaging tool in the management of perianorectal Crohn's disease.