山田 博康, 隅岡 正昭, 渡辺 千之, 佐藤 理, 永田 信二, 大下 恭弘, 石丸 正平, 宮本 真樹, 平田 研, 今川 勝

Hiroyasu YAMADA, Masaaki SUMIOKA, Chiyuki WATANABE, Osamu SATOH, Shinji NAGATA, Yasuhiro OSHIMO, Syouhei ISHIMARU, Masaki MIYAMOTO, Ken HIRATA, Masaru IMAGAWA

広島県立広島病院消化器内科

Depatrment of Gastroenterology, Hiroshima Prefectural Hiroshima Hospital

キーワード : Colonoscopy, Endoscopic miniature ultrasonography, Inflammatory bowel disease, Ultrasonography

To evaluate the usefulness of ultrasonography (US) in diagnosing active inflammatory bowel disease, US images were compared with those produced at the same stage by colonoscopy and miniature ultrasonography (MUS). Sixty-six patients were studied: 40 had ischemic colitis (IC); 19, ulcerative colitis (UC); and 7, drug-associated hemorrhagic colitis (DC). Thirty-seven healthy controls were used: 22 for MUS and 15 for US. The following three results were obtained. (1) Bowel-wall thickening was observed in patients with IC, UC, or DC on US and MUS. (2) US images were classified into the following two categories according to pattern of bowel-wall thickening observed: US images in which the border between the mucosal and submucosal layers of the bowel wall was unidentifiable and stratification of the bowel wall was unclear (the sausagelike pattern), and US images in which the border between the mucosal and submucosal layers of bowel wall was identifiable and stratification of bowel wall was clear (the sandwichlike pattern). With this classification, the US images from the 47 patients with IC or DC were classified as sausagelike pattern, while the US images from 16 of the 19 patients with UC were classified as the sandwichlike pattern. Images from the remaining 3 patients with UC were classified as sausagelike pattern, and colonoscopy showed the presence of severe UC. (3) On MUS, the thickened bowel walls of the patients with IC or DC consisted mainly of the submucosal layer, while the thickened bowel walls of patients with UC consisted mainly of the mucosal layer. These findings suggest that the US sausagelike pattern appears in patients in whom thickening is mainly in the submucosal layer, while the US sandwichlike pattern appears in patients in whom thickening is mainly in the mucosal layer.