Point‐of‐care gastrointestinal ultrasound in inflammatory bowel disease: An accurate alternative for disease monitoring

Sathananthan, Dharshan; Rajagopalan, Arvind; Ven, Lucinda Van de; Martin, Serena; Fon, James; Bryant, Robert V.

doi:10.1002/jgh3.12269

Cited by 13 publications

(9 citation statements)

References 25 publications

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“…Shatanantan et al compared POC IUS in 74 IBD patients with ileocolonoscopy in a blinded study, and found high sensitivity and specificity of POC IUS for detection of disease activity in both UC and CD. 22 A third study found also a high correlation for IUS and endoscopic disease activity in CD patients. 45 In our cohort we found similar findings.…”

Section: Discussionmentioning

confidence: 92%

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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

Bots

Voogd

Jong

et al. 2021

Journal of Crohn's and Colitis

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Introduction Intestinal ultrasound (IUS) is useful for assessment of inflammation, complications and treatment follow-up in inflammatory bowel disease (IBD) patients. We aimed to study outcomes and impact on disease management for point-of-care (POC) IUS in IBD patients. Methods Two patient cohorts undergoing POC IUS (January 2016 - July 2018 and October 2019 - December 2019) were included retrospectively. Disease management after IUS was analysed and IUS outcomes were compared with symptoms, biomarkers and additional imaging within 8 weeks from IUS. To study differences in use of IUS over time, cohorts were compared. Results In total, 345 examinations (280 in Crohn’s disease (CD)/65 in Ulcerative Colitis (UC)) were performed. Present inflammation on IUS was comparable between symptomatic and asymptomatic CD (67.6% vs 60.5%; p=0.291). In 60%, IUS had impact on disease management with change in medication in 47.8%. Additional endoscopy/MRI was planned after 32.8% examinations showing good correlation with IUS in 86.3% (ρ=0.70, p<0.0001) and 80.0% (ρ=0.75, p<0.0001) of cases, respectively. Fecal calprotectin was higher in active versus inactive disease on IUS (664 µg/g vs 79 µg/g; p<0.001). Over the years IUS was performed more frequently to monitor treatment response and the use of MRI was reduced within the cohort. Conclusions POC IUS affects clinical decision making and could detect pre-clinical relapse in CD patients with potential to reduce additional endoscopy or MRI. In addition, the paradigm expands towards monitoring treatment and close follow-up for IUS. Based on our results we propose a POC IUS algorithm for follow-up of IBD patients.

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Section: Discussionmentioning

confidence: 92%

“…Whereas studies have shown good accuracy and reliability of IUS, there are limited data on the impact of IUS outcomes on daily clinical decision making. 21 , 22 …”

Section: Introductionmentioning

confidence: 99%

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

Bots

Voogd

Jong

et al. 2021

Journal of Crohn's and Colitis

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“…It showed a 91% sensitivity and 83% specificity for detecting endoscopically active IBD, correlating with a positive predictive value (PPV) of 89%, a negative predictive value (NPV) of 86%, and a kappa coefficient of 0.74 (88%). POCUS-defined disease extent has a 87% sensitivity and 81% specificity, correlating with a PPV of 85% and NPV of 83% and a kappa coefficient of 0.70 (85%) [ 31 ].…”

Section: Resultsmentioning

confidence: 99%

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

et al. 2021

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Background Despite the current therapeutic options for the treatment of inflammatory bowel disease, surgery is still frequently required in the emergency setting, although the number of cases performed seems to have decreased in recent years. The World Society of Emergency Surgery decided to debate in a consensus conference of experts, the main pertinent issues around the management of inflammatory bowel disease in the emergent situation, with the need to provide focused guidelines for acute care and emergency surgeons. Method A group of experienced surgeons and gastroenterologists were nominated to develop the topics assigned and answer the questions addressed by the Steering Committee of the project. Each expert followed a precise analysis and grading of the studies selected for review. Statements and recommendations were discussed and voted at the Consensus Conference of the 6th World Society of Emergency Surgery held in Nijmegen (The Netherlands) in June 2019. Conclusions Complicated inflammatory bowel disease requires a multidisciplinary approach because of the complexity of this patient group and disease spectrum in the emergency setting, with the aim of obtaining safe surgery with good functional outcomes and a decreasing stoma rate where appropriate.

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“…Patients with inflammatory bowel diseases require frequent follow up to evaluate and adjust medical treatment. GIUS in a point-of-care setting has been shown to be accurate,[ 37 ] and the inclusion of POCUS in the decision-making leads to significant changes in disease management. [ 35 38 39 ] Evidence also suggests that the introduction of POCUS reduces the need for magnetic resonance (MR) enterography and colonoscopy.…”

Section: E Xamination T Echniques and ...mentioning

confidence: 99%

Point-of-care ultrasound of the gastrointestinal tract

Gilja

Nylund

2023

J Med Ultrasound

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The widespread use of portable ultrasound scanners has promoted the concept of point of care ultrasound (POCUS), namely “ultrasound performed bedside and interpreted directly by the clinician.” The purpose of this short review is to outline how POCUS can be used in patients with diseases of the gastrointestinal (GI) tract. POCUS is not a replacement for comprehensive ultrasound, but rather allows physicians immediate access to clinical imaging for rapid diagnosis and efficient work-up and treatment of the patients. There are many indications for doing POCUS of the GI tract, including abdominal pain, diarrhea, palpable masses, and to detect fluid or free air in the abdominal cavity. To improve the visibility of deeper parts of the abdomen, the graded compression technique with the scan head is useful. During POCUS, the operator should look for signs of severe pathology including target lesions, the pseudo-kidney sign, the onion sign, dilated bowel loops, gastric retention, free fluid, and free air, depending on the actual clinical problem. We conclude that POCUS of the GI tract is very useful to provide a rapid diagnosis in many clinical scenarios.

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Point‐of‐care gastrointestinal ultrasound in inflammatory bowel disease: An accurate alternative for disease monitoring

Cited by 13 publications

References 25 publications

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

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

WSES-AAST guidelines: management of inflammatory bowel disease in the emergency setting

Point-of-care ultrasound of the gastrointestinal tract

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