Point-of-care intestinal ultrasound in IBD patients: disease management and diagnostic yield in a real-world cohort and proposal of a point-of-care algorithm

Abstract

Introduction

Intestinal ultrasound (IUS) is useful for assessment of inflammation, complications and treatment follow-up in inflammatory bowel disease (IBD) patients. We aimed to study outcomes and impact on disease management for point-of-care (POC) IUS in IBD patients.

Methods

Two patient cohorts undergoing POC IUS (January 2016 - July 2018 and October 2019 - December 2019) were included retrospectively. Disease management after IUS was analysed and IUS outcomes were compared with symptoms, biomarkers and additional imaging within 8 weeks from IUS. To study differences in use of IUS over time, cohorts were compared.

Results

In total, 345 examinations (280 in Crohn’s disease (CD)/65 in Ulcerative Colitis (UC)) were performed. Present inflammation on IUS was comparable between symptomatic and asymptomatic CD (67.6% vs 60.5%; p=0.291). In 60%, IUS had impact on disease management with change in medication in 47.8%. Additional endoscopy/MRI was planned after 32.8% examinations showing good correlation with IUS in 86.3% (ρ=0.70, p<0.0001) and 80.0% (ρ=0.75, p<0.0001) of cases, respectively. Fecal calprotectin was higher in active versus inactive disease on IUS (664 µg/g vs 79 µg/g; p<0.001). Over the years IUS was performed more frequently to monitor treatment response and the use of MRI was reduced within the cohort.

Conclusions

POC IUS affects clinical decision making and could detect pre-clinical relapse in CD patients with potential to reduce additional endoscopy or MRI. In addition, the paradigm expands towards monitoring treatment and close follow-up for IUS. Based on our results we propose a POC IUS algorithm for follow-up of IBD patients.

Author notes

S. Bots and F. de Voogd contributed equally