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

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.