In this video, Dr Dolinger, from the Icahn School of Medicine at Mt Sinai in New York City, discusses his presentation at the virtual regional meeting of Advances in Inflammatory Bowel Disease about the advantages of using intestinal ultrasound in the IBD clinic.

Michael Dolinger, MD, is an advanced pediatric IBD fellow at the Icahn School of Medicine at Mt Sinai in New York City. 

TRANSCRIPT:

Hi, my name is Michael Dolinger. I'm a pediatric advanced inflammatory bowel disease fellow at the Icahn School of Medicine in Mount Sinai.

Thank you for attending the AIBD Regional, where I had the pleasure to speak about the emerging role of intestinal ultrasound at the point of care in the clinic. I wanted to highlight a few things from my talk that will provide some extra information and background.

First, intestinal ultrasound is traditional transabdominal ultrasound that is performed routinely during a routine clinic visit. It takes about 10 minutes in which a patient lies supine on the bed. We place a probe on their abdomen, and we get high-definition views of the entire colon except for the rectum and the end of the small intestine and terminal ileum, in which we can measure the bowel wall thickness. We can look for blood flow and signs of inflammation that are signs of active and chronic inflammation.

This technique is widely used in Europe, Canada, Israel, but is really starting to take off slowly in the United States. Most importantly, it really has served to enhance shared understanding between the patient and provider.

I think if anything can be taken away from the talk it's that this is a real-time biomarker, a real-time tool that you can use where a patient can see their information and inflammation on the screen. They can then use that to develop understanding of their disease, their treatment response. It can enhance their need to take medications, change of therapy, and really facilitate a conversation between the provider and the patient. It's really an unbelievable tool to use to enhance shared understanding.

In order to perform intestinal ultrasound, there is extreme benefits over other modalities. There's no preparation. There's no fasting. There's no contrast. There's no IV. There's no venipuncture for children. There is no sedation. This can really be done at any clinic visit. You don't need to make an appointment. And I can't stress enough that this is real time. This isn't a radiologist. This is a gastroenterologist really communicating the results to the patient and making the decision on the spot.

And so, there are a lot of questions about accuracy and how to actually use this. There are multiple studies that demonstrate that intestinal ultrasound has very similar accuracy to MRE for predicting inflammation. And scores—a simple ultrasound score for Crohn's Disease and a simple ultrasound score for ulcerative colitis — correlate better with endoscopy than CRP, fecal calprotectin, and clinical biomarkers.

So, it's really a great tool to correlate with endoscopic inflammation, and you can use it serially to monitor treatment response.

You take a tool that's not MRI, that's not CAT scan, it doesn't have the radiation. It's not a colonoscopy. It's not blood work that results outside of the clinic visit. It's not a stool test which patients struggle with compliance.

You have now a tool in which you can visualize inflammation without any preparation, serially, and compare treatment response over time. That's what we're starting to do, is we're starting to look at how fast can we see treatment response, and how can we use this as a tight control monitor of inflammation for both Crohn's disease and ulcerative colitis.

That's how we build the key to changing the natural history of Crohn's disease or ulcerative colitis, is really using this as a tight control monitor to prevent disease flares. We're finding that when patients still have inflammation on ultrasound, they've had a normalization of their clinical…they're in clinical remission. Their biomarkers have normalized, their calprotectin and CRP, but we can still find inflammation on an ultrasound that we can then dose adjust their therapy for. This is really a unique benefit of the tool. It takes about ten minutes. It's easy to perform.

So if I can highlight the main points that I want you to take away, it's that we have a real-time, noninvasive tool you can use serially in the clinic to help patients understand their disease better, make decisions, and gain better control of their inflammation.

You can use that as a tight control monitor over a period of time to prevent chronic bowel damage from occurring. Really an incredible, incredible tool that's underutilized in the United States, but it's slowly beginning to take off, and I want this presentation to help inspire other centers in other places to begin to use this tool and start training.