Superior predictive value of transmural over endoscopic severity for colectomy risk in ulcerative colitis: a multicentre prospective cohort study

• Published in: Journal of Crohn's and colitis 2024-02, Vol.18 (2), p.291-299
• Main Authors: Piazza O Sed, Nicole, Noviello, Daniele, Filippi, Elisabetta, Conforti, Francesco, Furfaro, Federica, Fraquelli, Mirella, Costantino, Andrea, Danese, Silvio, Vecchi, Maurizio, Fiorino, Gionata, Allocca, Mariangela, Caprioli, Flavio
• Format: Article
• Language: English
• Subjects: Adult; Colectomy; Colitis, Ulcerative - diagnostic imaging; Colitis, Ulcerative - surgery; Colonoscopy; Humans; Intestinal Mucosa - surgery; Original; Prospective Studies; ROC Curve; Severity of Illness Index
• ISSN: 1873-9946; 1876-4479
• DOI: 10.1093/ecco-jcc/jjad152

Endoscopic activity is associated with an increased risk of surgery in patients with ulcerative colitis [UC]. Transmural activity, as defined by Milan Ultrasound Criteria [MUC] > 6.2, reliably detects endoscopic activity in patients with UC. The present study aimed to assess in UC patients whether transmural severity is a better predictor of colectomy as compared to endoscopy. Consecutive adult UC patients were recruited in two IBD Referral Centres and underwent colonoscopy and intestinal ultrasound in a blinded fashion. The need for colectomy was assessed at follow-up. Univariable and multivariable logistic and Cox regression analyses were performed. Receiver operating characteristic [ROC] analysis was used to compare MUC baseline values and Mayo Endoscopic Scores [MES] in predicting colectomy risk. Overall, 141 patients were enrolled, and 13 underwent colectomy in the follow-up period. Both MES (hazard ratio [HR]: 3.15, 95% confidence interval [CI]: 1.18-8.37, p = 0.02) and MUC [HR: 1.48, 95% CI: 1.19-1.76, p