Impact of intestinal ultrasound with a portable system in the management of Crohn's disease

Can Gonen; Ali Surmelioglu; Koray Kochan; Serhat Ozer; Ekrem Aslan; Metin Tilki

doi:10.1093/gastro/goaa088

Impact of intestinal ultrasound with a portable system in the management of Crohn's disease

Gastroenterol Rep (Oxf). 2020 Dec 10;9(5):418-426. doi: 10.1093/gastro/goaa088. eCollection 2021 Oct.

Authors

Can Gonen^{1

2}, Ali Surmelioglu³, Koray Kochan², Serhat Ozer², Ekrem Aslan², Metin Tilki³

Affiliations

¹ Department of Gastroenterology, School of Medicine, Acibadem Mehmet Ali Aydınlar University, Istanbul, Turkey.
² Department of Gastroenterology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
³ Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.

Abstract

Background: Intestinal ultrasound (IUS) is a valid cross-sectional imaging technique for the evaluation of Crohn's disease (CD). With advancements in technology, portable ultrasound systems are becoming widely available, and the inevitable change to their use by non-radiologist clinicians would be a valuable contribution to improving patient care. This study aimed to investigate the diagnostic yield of IUS examination performed by a gastroenterologist with a portable system as an adjunct imaging modality in the routine care of CD patients.

Methods: A total of 117 CD patients were assessed by IUS imaging. Pre- and post-IUS clinical-management decisions were recorded. The primary outcome was to evaluate the change in the patients' clinical-management decision following the IUS examination. The diagnostic accuracy was compared against the reference decision reached via a multidisiplinary meeting after the evaluation of all patient-related data. The endoscopic disease activity was determined using the simple endoscopic score for Crohn's disease (SES-CD).

Results: The initial clinical-management decision was changed in 47 patients (40.2%) after the IUS examination (P = 0.001). The accuracy of patient-management decisions improved from 63.2% to 90.6% in comparison to reference decisions (P < 0.001). After IUS examination, a further 13 cases (11.1%) were identified for urgent surgical/interventional procedures. The accuracy of colonoscopic (SES-CD ≥3) assessment was shown to be comparable to that of IUS (94% vs 91%). The sensitivity for disease presence was 95% with colonoscopy and 94% with the IUS assessment.

Conclusion: IUS examination with the use of a portable ultrasonography system significantly improves clinical-management decisions. With further supporting data, this practice would possibly become a requirement for CD management.

Keywords: Crohn’s disease; inflammatory bowel diseases; monitoring; point-of-care; portable; ultrasound.