Endosonographic differentiation of mucosal and transmural nonspecific inflammatory bowel disease

Thirty-seven patients with nonspecific inflammatory bowel disease were examined with an ultrasonic colonoscope and the inflammation classified as mucosal or transmural. Mucosal inflammation was characterized by preservation of the five-layer structure of the wall with thickening of the submucosa. Transmural inflammation was endosonographically defined as sectional interruption or loss of the five-layer structure. In 14 of the 37 patients a colectomy was performed. Examination of 3 of the 14 resected specimens revealed inflammation confined to the mucosa. This was consistent in all three cases with the preoperative endosonographic evaluation. Eleven of the 14 resected specimens showed sectional transmural inflammation. Ultrasonographically all of the 11 patients fulfilled the criteria for transmural inflammation, whereas endoscopic and microscopic signs were consistent with transmural inflammation in 9 of the 11. Endosonography of the colon enables definition of mucosal inflammation thus providing criteria for selection of patient for ileoanal pouch construction.