Ultrasound instead of endoscopy – this fast, easy examination is particularly beneficial for patients with chronic inflammatory bowel disease. Gerhard Rogler, Head of the Department of Gastroenterology and Hepatology, talks about the advantages for both patients and physicians.
Prof. Rogler, you often use ultrasound rather than endoscopy when examining your patients. For which patients do you use ultrasound?
We use ultrasound rather than endoscopy with patients who have chronic inflammatory bowel diseases such as diverticulitis. We not only use it to investigate acute symptoms but also to monitor the progression of the disease and the efficacy of the treatment in the long term. In some cases, we also use ultrasound as an alternative to computed tomography (CT).
Ultrasound has been around for a long time. Why is it only being used this way now?
It’s true that the technology has been around for a long time, but only the very latest generation of ultrasound devices has been able to provide images of such high resolution that ultrasound can replace endoscopy.
What are the advantages of ultrasound for these patients compared to endoscopy or CT?
There’s a long list of advantages for these patients! In short, ultrasound examinations are quick, easy, and have no side effects. They are also a lot cheaper.
Can you explain the advantages for patients in more detail?
Patients with chronic bowel disease frequently have several flare-ups a year; in many cases, they also have diffuse abdominal pain. However, they may have to wait a long time for an endoscopy, plus endoscopy requires a certain degree of preparation. Ultrasound, on the other hand, is very helpful for finding out the cause of the symptoms as quickly as possible and initiating specific treatment without delay. Ultrasound is also an efficient way of monitoring the progression of the disease and the efficacy of the treatment. What’s more, it provides information that allows the doctor to decide whether a treatment should continue or whether the patient can discontinue it. It also enables us to determine whether the symptoms signal a recurrent bout of inflammation or have a quite different, harmless cause.
Which side effects can be avoided?
A CT always exposes the patient to a certain amount of radiation. Particularly in young patients, it is important to keep this exposure to a minimum. Clearly it’s an immense improvement if we can get the same information from a completely radiation-free ultrasound as we get from repeated CT scans.
So there are plenty of advantages for the patients. What about the quality of the diagnosis?
When used like this for diagnostic purposes, ultrasound has the same sensitivity and specificity as CT or MRI. Ultrasound also allows us to see the deeper layers of the intestines and determine whether the blood flow in this area is increased. This is a sure sign of inflammation that we would not be able to detect during an endoscopy, which only shows the surface of the intestinal mucosa. Studies have shown that the surface heals faster than the deeper layers, and a superficial examination could therefore be deceptive.
In your opinion, what are the positive aspects for the treating physician?
Ultrasound gives us as many images as we want. These are helpful when making a diagnosis and monitoring the progression of the disease over lengthy periods of time. These days, the equipment is also mobile. Being able to talk to the patient during the scan is a significant advantage, since it helps both the patient and the physician. During a colonoscopy, the patient is usually sedated and doesn’t register what is happening; during a CT, he lies in the scanner and the results are communicated in writing.
Ultrasound enables the patient to see what’s going on inside their abdomen and ask questions right away. And if I see an area that looks suspicious, I can palpate it right away and the patient can tell me if and where it hurts.
Endoscopy is still recommended for colon cancer screening. Why isn’t ultrasound used in this situation?
During an ultrasound, the sound waves are reflected by intestinal gas, which means we can only see 180° of the intestine. Unlike ultrasound, a colonoscopy allows us to see the side of the bowel further away from the abdominal wall. Ultrasound also misses smaller polyps, which can develop into bowel cancer. This is why endoscopy and colonoscopy have a critical advantage in terms of screening for colon cancer. Small polyps can be removed in one go during the examination. So although colonoscopy is more unpleasant than ultrasound, it’s the best way to prevent colon cancer and detect it in its early stages. In this respect, it is still irreplaceable.