Usefulness of endoscopic ultrasound for perianal fistula in Crohn's disease.

ABSTRACT Objective: to determine the role of endoscopic ultrasonography (EU) in comparison with nuclear magnetic resonance imaging (MRI) and examination under anesthesia (EUA) in the management of patients with perianal fistulizing Crohn's disease. Methods: we conducted a cross-sectional, observational study with patients with perianal Crohn's disease evaluated at a tertiary center in Curitiba, Paraná, Brazil, from February 2016 to March 2017. All patients underwent EU, MRI and EUA. We evaluated the degree of agreement between the three methods by obtaining the Kappa coefficient. A Kappa value of 0.7 or greater indicated good agreement. We used the Friedman's non-parametric test to compare the number of fistulous paths detected in each modality. We set the level of statistical significance at p<0.05. Results: we included 20 patients. There was agreement between the three exams in 11 patients. The level of Kappa agreement between the three exams was 0.53 (moderate - p<0.001). There was no statistically significant difference in relation to the number of fistulous trajectories detected in the three exams (p=0.641). EU failed to identify a fistulous pathway in three patients; MRI failed in three; and EUA failed in two. Conclusion: EU was comparable to MRI and EUA for the evaluation of perianal fistulizing Crohn's disease, and can be considered a valid exam for preoperative investigation of such patients.

摘要
目的：明确内镜超声检查（endoscopic ultrasonography, EU）相较于核磁共振成像（magnetic resonance imaging, MRI）与麻醉下检查（examination under anesthesia, EUA），在肛周瘘管型克罗恩病患者诊疗中的应用价值。
方法：本研究为横断面观察性研究，纳入2016年2月至2017年3月期间，巴西巴拉那州库里提巴某三级医疗中心收治的肛周克罗恩病患者。所有受试者均接受EU、MRI及EUA三项检查。通过计算Kappa系数评估三种检查方法的一致性水平，Kappa值≥0.7提示一致性良好。采用弗里德曼非参数检验对比三种检查方式检出的瘘管数量，设定统计学显著性阈值为p<0.05。
结果：本研究共纳入20例患者。其中11例患者的三项检查结果完全一致。三种检查方法间的Kappa一致性系数为0.53（中等一致性，p<0.001）。三种检查方式检出的瘘管走行数量无统计学显著性差异（p=0.641）。EU漏诊3例患者的瘘管通道，MRI漏诊3例，EUA漏诊2例。
结论：EU在肛周瘘管型克罗恩病的评估中与MRI、EUA效果相当，可作为该类患者术前评估的有效检查手段。