Bedside Intestinal Ultrasound Performed in an Inflammatory Bowel Disease Urgent Assessment Clinic Improves Clinical Decision-Making and Resource Utilization

• Published in: Crohn's & colitis 360 Vol. 5; no. 4; p. otad050
• Main Authors: St-Pierre, Joëlle, Delisle, Maxime, Kheirkhahrahimabadi, Hengameh, Goodsall, Thomas M, Bryant, Robert V, Christensen, Britt, Vaughan, Rose, Al-Ani, Aysha, Ingram, Richard J M, Heatherington, Joan, Carter, Dan, Lu, Cathy, Ma, Christopher, Novak, Kerri L
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 01.10.2023
• Subjects: Innovations in Care Delivery; COVID-19; ulcerative colitis; intestinal ultrasound; point-of-care ultrasound; inflammatory bowel disease; Crohn’s disease
• ISSN: 2631-827X; 2631-827X
• DOI: 10.1093/crocol/otad050

Abstract Background Patients with inflammatory bowel disease (IBD) require accessible, timely, and noninvasive strategies to monitor disease. The aim was to assess the integration of intestinal ultrasound (IUS) on decision-making and endoscopy utilization in a standardized care pathway. Methods This prospective, multicenter, international, observational cohort study included patients seen within a centralized model for IBD care was conducted during the COVID pandemic. Patients were evaluated with IUS alone or in combination with an in-clinic, unsedated sigmoidoscopy. Demographic, clinical, laboratory, and imaging data, clinical decisions, and need for urgent endoscopy, hospitalization, and surgeries were recorded. Results Of the 158 patients included, the majority had an established diagnosis of Crohn’s disease (n = 123, 78%), and 47% (n = 75) of patients were on biologic therapy. IUS identified active inflammation in 65% (n = 102) of patients, and strictures in 14% (n = 22). Fecal calprotectin levels correlated with inflammation detected on IUS (median of 50 μg/g [Q1–Q3: 26–107 μg/g] without inflammation and 270 μg/g [Q1–Q3: 61–556 μg/g] with inflammation; p = 0.0271). In the majority of patients, clinical assessment with IUS led to an acute change in IBD-specific medications (57%, n = 90) and avoided or delayed the need for urgent endoscopy (85%, n = 134). Four patients were referred for urgent surgical consultation. Conclusions Point-of-care IUS used in a flare clinic pathway is a useful strategy to improve effective IBD care delivery and to assist in therapeutic management decisions, in many cases avoiding the acute need for endoscopy. Lay Summary This multicenter study shows that point-of-care intestinal ultrasound is an accurate noninvasive tool that can detect bowel inflammation, avoid or delay the need for urgent endoscopy, and lead to actionable changes in therapeutic management in patients with inflammatory bowel disease. Graphical Abstract Graphical Abstract