Intestinal ultrasound ‘a very accurate and useful modality’

Intestinal ultrasound (IUS) should be used more in the monitoring and assessment of inflammatory bowel disease (IBD) patients, as it is accurate, non-invasive and cost-effective, the Irish Society of Gastroenterology Winter Meeting 2023 heard.

Prof Kerri Novak, Consultant Gastroenterologist, Professor of Medicine, University of Calgary, Canada, an internationally renowned expert on the topic, said that despite the proven use of IUS in evaluation of the small and large bowel for inflammation, perforation, diverticulitis, and acute bowel obstruction, gastroenterology remains well behind other specialties in the adoption of this safe and effective diagnostic tool, which can be used at the bedside.

Prof Novak cited a number of IUS studies showing positive results in relation to high accuracy for detection of inflammation, fibrosis, and post-operative complications, as well as being preferred by patients over colonoscopy and being resource-saving.

This evidence included a multicentre, international, observational cohort study, which Prof Novak was involved in, assessing IBD patients for potential flares during the Covid-19 pandemic. Patients were evaluated with IUS alone or in combination with an in-clinic, unsedated sigmoidoscopy. IUS identified active inflammation in two-thirds (n=102) of patients, and strictures in 14 per cent (n=22). Faecal calprotectin levels correlated with inflammation detected on IUS. In the majority of patients, clinical assessment with IUS led to an acute change in IBD-specific medications (57 per cent, n=90) and avoided or delayed the need for urgent endoscopy (85 per cent, n=134). “Those results are very reassuring; that it is a very safe and accurate modality.”

Prof Novak also implored delegates to “image ulcerative colitis patients more often”.

Speaking to the Medical Independent, Prof Novak said she had three key takeaway messages from her presentation.

“Number one, we have limited tools at the bedside and so this provides information that is indispensable, every day, at the bedside,” she said.

“Secondly, because we can see the bowel move and in cross section, it teaches us about the gut, similar to a cardiologist with an Echo… and thirdly, our guidelines currently do not include patient wishes into what tools we use… they have to have input, and if they did, they would pick ultrasound.”