Point-of-Care Intestinal Ultrasound Impacts Inflammatory Bowel Disease Care and Reduces the Need for Additional Investigations

Abstract

Background and Aim: Intestinal ultrasound (IUS) has emerged as a widely used point-of-care (POC) tool for guiding inflammatory bowel disease (IBD) treatment. This study aims to assess the impact of POC IUS on clinical decision-making in IBD. Methods: We performed a retrospective review of outpatient cases utilizing POC IUS at a tertiary center between October 2021 and March 2023. We established a control group through retrospective case review by two experienced IBD specialists whose management decisions were based solely on clinical presentations, without access to IUS results. These decisions were then compared to those made when IUS information was available to evaluate the impact of IUS on IBD patient care. We assessed the association of variables using χ2 test. Results: Among the 447 IUS examinations analyzed, 45% showed active disease. Abnormal IUS prompted management changes in symptomatic patients more often than in asymptomatic ones (67% vs. 35%, p < 0.001). Without IUS data, more investigations were recommended, including stool testing (51% vs. 9%, p < 0.0001), imaging (22% vs. 4%, p < 0.0001), and endoscopy (39% vs. 9%, p < 0.0001). The rates of escalation to corticosteroids (16% vs. 7%, p < 0.0001) and advanced therapy (22% vs. 12%, p < 0.0001) were notably higher in the control group. IUS significantly correlated with fecal calprotectin (FCP) levels (p < 0.0001), endoscopic disease activity (p = 0.002), and magnetic resonance (MR) imaging (p = 0.047). Conclusion: This study highlights the significant impact of POC IUS in guiding patient management decisions, reducing additional investigations and potential overtreatment. Furthermore, IUS results consistently aligned with findings from FCP, endoscopy, and MR imaging.