Transperineal ultrasound predicts endoscopic and histological healing in ulcerative colitis

Shintaro Sagami, Taku Kobayashi, Kanako Aihara, Misaki Umeda, Hiromu Morikubo, Mao Matsubayashi, Hiroki Kiyohara, Masaru Nakano, Makoto Ohbu, Toshifumi Hibi

Research output: Contribution to journalArticlepeer-review

55 Citations (Scopus)


Background: Transabdominal ultrasound is useful to assess inflammation in patients with ulcerative colitis (UC); however, the assessment of the rectum is challenging and a barrier for its widespread use. Aim: To evaluate if transperineal ultrasound is useful for predicting endoscopic and histological findings of the rectum in UC. Methods: Fifty-three consecutive adults with UC who required colonoscopy were included and transperineal ultrasound was performed in combination with transabdominal ultrasound within a week before or after colonoscopy with rectal biopsy. Mayo endoscopic subscore (MES) ≤1 was defined as endoscopic healing and Geboes score <2.1, Robarts histopathology index ≤6, and Nancy index ≤1 were defined as histological healing. Limberg score and bowel wall thickness were recorded with transperineal ultrasound. Faecal calprotectin was also measured. Results: Excellent correlation was confirmed between colonoscopy and transabdominal ultrasound in all segments except for the rectum. Rectal bowel wall thickness and Limberg score in transperineal ultrasound well correlated with rectal MES and histological indices. Bowel wall thickness ≤4 mm predicted endoscopic (Area under the curve [AUC] = 0.90) and histological (AUC = 0.87-0.89) healing. In multivariable logistic regression analysis, only bowel wall thickness in transperineal ultrasound was a significant independent predictor for rectal endoscopic and histologic healing (P < 0.05) and the predictability was better than faecal calprotectin. Conclusions: Transperineal ultrasound predicts endoscopic and histological healing of the rectum. The combination of transperineal ultrasound with transabdominal ultrasound visualises the entire colorectum and is an ideal modality for the treat-to-target strategy. Clinical Trials Registry number UMIN000033611 (

Original languageEnglish
Pages (from-to)1373-1383
Number of pages11
JournalAlimentary Pharmacology and Therapeutics
Issue number12
Publication statusPublished - 2020 Jun 1
Externally publishedYes

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology
  • Pharmacology (medical)


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