Obligatory medical device diagnostics.
- Sonography (ultrasonography) – as a basic diagnostic tool when chronic inflammatory bowel disease is suspected; if necessary, additional hydrocolon sonography (sonography of the colon (intestine) under retrograde fluid installation: in ulcerative colitis, the intestinal wall is only slightly thickened and the five-layer wall structure is preserved; in M. Crohn’s, however, the colon wall is thickened and the typical stratification is no longer consistently recognizable) [characteristic of ulcerative colitis: continuous wall thickening, usually with punctum maximum in the left lower abdomen].
- Ileocolonoscopy (endoscopic visualization of the intestine and small bowel; with high-resolution chromoendoscopy with vital staining or high-resolution white light endoscopy) -.
- As a basic diagnostic test for suspected chronic inflammatory bowel disease; biopsies from the term. Ileum and all colonic segments including the rectum (at least two biopsies/segment; sent in separate specimen containers) [Endoscopic findings: blurred ulceration (ulceration); hyperemic mucosa that bleeds easily on contact; pseudopolyps (stagnant mucosal areas)Depending on the pattern of involvement, a distinction is made as follows:
- Biopsies (tissue sampling): in addition to targeted biopsies, random step biopsies should be taken.
- Histological findings (fine tissue findings): inflammation confined to the mucosa, granulocyte accumulation (granulocytes: small subgroup from the group of white blood cells) in the crypts (crypt abscess), goblet cell loss; late stage: mucosal atrophy and epithelial dysplasia (cancer precursor of an epithelial alteration]
- Colonoscopy for early cancer detection:
- 6-8 year after initial diagnosis of ulcerative colitis (inflammation of the entire colon), regardless of disease activity.
- If disease activity is limited to the rectum (rectum) without evidence of prior or current endoscopic and/or microscopic inflammation proximal to the rectum, inclusion in a regular surveillance colonoscopy program should not occur [S3 guideline].
- Examination intervals
- Every 4 years for low risk (none of the factors listed below are present).
- Every 2-3 years for intermediate risk (colitis with mild or moderate inflammation, many pseudopolyps, first-degree relative with CRC ≥ 50 yr).
- Annually at
- Concurrent presence of primary sclerosing cholangitis (PSC).
- High risk (ulcerative colitis, in the presence of stenosis, in the presence of intraepithelial neoplasia in the past five years, or in the presence of early CRC in first-degree relatives)
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnosis (differentiation of Crohn’s disease).
- CT/MR colography as CT enterography (or enteroclysma) or MRI enterography (or enteroclysma) (to visualize the loops of the small intestine) – as an alternative procedure to ileocolonoscopy.
- MR enteroclysma or CT sellink or conventional enteroclysma – to differentiate from Crohn’s disease [house stent atrophy (long smooth colon, “bicycle tube”); pseudopolyps]
- MRI colonography [evidence of typical absent haustration; backwash ileiitis]
- X-ray abdomen survey – to rule out toxic megacolon (life-threatening complication of ulcerative colitis that rapidly progresses to acute dilatation of the colon) [massive dilatation (expansion) of intestinal loops (diameter > 6 cm) and lack of haustration/pleating of the colon]
Carcinoma prophylaxis
- The new European Crohn’s and Colitis Organization (ECCO) guidelines recommend endoscopic monitoring in all patients from the eighth year onward, regardless of the pattern of involvement. Only patients with rectal-only involvement no longer need to be monitored. The method of choice is chromoendoscopy with methylene blue or indigo carmine blue and additional targeted biopsies from conspicuous areas.
