Point-of-Care Intestinal Ultrasound Reduces Need for MRIs

While intestinal ultrasound (IUS) is already proven to be helpful in treatment follow-up among patients with inflammatory bowel disease (IBD), new research proposes a point-of-care (POC) IUS algorithm for a more effective follow-up and treatment strategy. The research is published in the Journal of Crohn’s and Colitis.

“Chronic and relapsing patterns cause long-term bowel damage and complications such as stenosis and perforating disease in Crohn’s disease (CD) patients,” the researchers noted. “Therefore, complete and objective control of inflammation is the preferred treatment target leading to superior long-term outcomes. Currently, this ‘treat to target’ concept is the ultimate strategy in the treatment of IBD patients.”

The researchers included 2 patient groups undergoing POC IUS (January 2016–July 2018 and October 2019–December 2019) Among the 345 total patients, 280 had CD and 65 had ulcerative colitis (UC). The end purpose was to determine disease management by evaluating IUS, comparing IUS outcomes with symptoms, determining biomarkers, and performing additional imaging within 8 weeks from IUS.

Upon comparing the 2 groups, the study evaluated the differences in use of IUS over time. After IUS, disease management changed among 60% of the patients. While 47.8% of the cases underwent an alteration in medication, 32.8% of the patients underwent additional endoscopy or magnetic resonance imaging (MRI). Additionally, the researchers observed that 86.3% of the cases showed good correlation with IUS and that fecal calprotectin was higher in active versus inactive disease on IUS (664 µg/g vs 79 µg/g)

The study revealed that the patients underwent IUS with increased frequency for monitoring treatment response and subsequently reduced the use of MRI.

“To illustrate the use of POC IUS in daily clinical practice, we propose an algorithm which may have the potential to reduce unnecessary additional evaluation in the future and to reduce delay in disease management,” the researchers advised. “We also propose to assess treatment response at different time points in CD and UC patients, since recent studies suggest that UC patients respond to treatment earlier than CD patients.”

The researchers concluded that POC IUS may benefit in detecting preclinical relapse in CD patients, which may in turn, reduce additional endoscopy or MRI. Therefore, the study encourages a POC IUS algorithm for close follow-up of IBD patients and effective treatment monitoring.

—Priyam Vora

Reference:
Bots S, De Voogd F, De Jong M, et al. 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. J Crohns Colitis. 2022; 16(4): 606–615. https://doi.org/10.1093/ecco-jcc/jjab175