Comparative Acceptability and Perceived Clinical Utility of Monitoring Tools

Buisson, Anthony; Gonzalez, Florent; Poullenot, Florian; Nancey, Stéphane; Sollellis, Elisa; Fuméry, Mathurin; Pariente, Benjamin; Flamant, Mathurin; Trang-Poisson, Caroline; Bonnaud, Guillaume; Mathieu, Stéphane; Thevenin, Alain; Duruy, Marc; Filippi, Jérôme; Lhopital, François; Luneau, Fabrice; Michalet, Véronique; Genes, Julien; Achim, Anca; Cruzille, E.; Bommelaer, Gilles; Laharie, David; Peyrin–Biroulet, Laurent; Pereira, Bruno; Nachury, Maria; Bouguen, Guillaume

doi:10.1097/mib.0000000000001140

Cited by 178 publications

(127 citation statements)

References 49 publications

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“…Accordingly, GIUS was ranked as the preferred tool for monitoring by the evaluated IBD cohort. Previous studies in IBD have shown that noninvasive tests are preferred to invasive tests, such as colonoscopy, because of factors such as the need for bowel preparation and discomfort of the test . In this study, GIUS was preferred over all other tests, including noninvasive options such as blood collection and stool sampling.…”

Section: Discussionmentioning

confidence: 97%

“…As opposed to previous studies assessing acceptability of IBD tools, this study also looked at the impact on disease‐related knowledge, and to the author's knowledge, this is the first study performed in Australia to evaluate GIUS in this manner. Although there is no validated tool for evaluating patient perceptions of diagnostic tests, a VAS was used, which was similar to previous studies . Administration of a questionnaire soon after a test also raises the possibility of recall bias in reporting comparative acceptability.…”

Section: Discussionmentioning

confidence: 99%

“…Following GIUS examination, study participants were asked to complete a questionnaire evaluating their experience of GIUS (Table S1, Supporting information). In the absence of another validated tool for measuring the experience of diagnostic tools, a visual analogue scale (VAS) from 0 (completely disagree) to 10 (strongly agree) was used . The acceptability of GIUS as a monitoring tool in IBD was measured (where 0 was completely unacceptable and 10 was completely unacceptable), as was its tolerability (where 0 was no discomfort and 10 was much discomfort).…”

Section: Methodsmentioning

confidence: 99%

“…Patient perceptions of tools for monitoring IBD are often overlooked. Endoscopic assessment is invasive and requires bowel preparation, as do other imaging modalities . There is a paucity of data evaluating patients' experience of monitoring tools in IBD.…”

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal ultrasound in inflammatory bowel disease care: Patient perceptions and impact on disease‐related knowledge

Rajagopalan

Sathananthan

et al. 2019

JGH Open

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Background and Aim Objective monitoring of disease activity is integral to therapeutic decision‐making in inflammatory bowel disease (IBD). Data are sparse on patients' perspectives of tools used to monitor disease activity in IBD. To evaluate patients' perspectives of gastrointestinal ultrasound (GIUS) performed during routine IBD clinical care, along with its impact on IBD‐specific knowledge. Methods Patients with a formal diagnosis of IBD who underwent GIUS at two tertiary IBD services between March 2017 and January 2019 participated in this prospective study. Participants completed a questionnaire measuring the acceptability, tolerability, and usefulness of GIUS using a visual analogue scale (VAS) from 0 (disagree) to 10 (strongly agree). Comparative acceptability of IBD monitoring tools and the impact of GIUS on IBD‐specific knowledge was measured. Results A total of 121 participants completed the questionnaire, with a mean age of 42 years (range 17–78), 54 (45%) males, and 79 (65%) Crohn's disease patients. In the overall population, GIUS was scored as highly acceptable for monitoring IBD (mean 9.20 ± 1.37) compared to colonoscopy (7.94 ± 2.30), stool sampling (8.17 ± 1.96), blood sampling (8.87 ± 1.62), and imaging (8.67 ± 1.60); P < 0.01 for each comparison. GIUS caused little patient discomfort (1.88 ± 1.83), and 98 (81%) participants ranked GIUS as their preferred IBD monitoring tool. GIUS also improved patients' overall IBD‐specific knowledge (VAS IBD‐specific knowledge 7.96 ± 1.92), including their understanding of the need for medical therapy and disease extent. Conclusion GIUS is a highly acceptable and well‐tolerated tool for monitoring disease activity in IBD patients. GIUS is preferred by patients and enhances IBD‐specific knowledge.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gastrointestinal ultrasound in inflammatory bowel disease care: Patient perceptions and impact on disease‐related knowledge

Rajagopalan

Sathananthan

et al. 2019

JGH Open

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“…This perception, however, may be inaccurate as a flexible sigmoidoscopy is not risk free, requires preparation, is typically performed with sedation, and may not be accepted by all patients. In a nationwide French study assessing the acceptability of monitoring tools in IBD, flexible sigmoidoscopy was considered the least acceptable monitoring tool by patients with UC compared to venipuncture, FC, and ileocolonoscopy . Our findings suggest that POCUS can be effectively used as an alternative tool to monitor disease activity in patients with UC with disease extending beyond the rectum.…”

Section: Discussionmentioning

confidence: 70%

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

et al. 2019

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Background and Aim Point‐of‐care ultrasound (POCUS) is a noninvasive alternative to ileocolonoscopy for monitoring disease activity in inflammatory bowel disease (IBD) but is underutilized in practice. Accuracy data are needed to engender clinician confidence in POCUS and increase uptake. The aim of this study was to evaluate the accuracy of POCUS compared to ileocolonoscopy in detecting active disease and extent in patients with IBD. Methods A prospective, blinded study was performed at a single tertiary center in South Australia between May 2017 and May 2018. Consecutive patients with a formal diagnosis of IBD who underwent both POCUS and ileocolonoscopy within 30 days of one another, performed to evaluate IBD disease activity, were eligible for participation. The accuracy of POCUS compared to ileocolonoscopy was assessed using sensitivity, specificity, and Cohen's kappa coefficient analyses. Results A total of 74 patients were included in the final analysis, 35 (47%) of whom had Crohn's disease and 39 (53%) ulcerative colitis; 37 subjects (50%) underwent a POCUS and ileocolonoscopy on the same day. POCUS demonstrated 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 with 87% sensitivity and 81% specificity, correlating with a PPV of 85% and NPV of 83% and a kappa coefficient of 0.70 (85%). Conclusion POCUS is accurate in defining disease activity and extent in IBD compared to ileocolonoscopy. POCUS represents an appealing, noninvasive alternative to ileocolonoscopy for monitoring disease activity in IBD.

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Accuracy of point‐of‐care intestinal ultrasound for Crohn's disease

Wright

Wang

Wong

et al. 2020

Australas J Ultrason Med

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Background Point‐of‐care ultrasound (POCUS), performed by a gastroenterologist, provides safe and convenient imaging allowing for immediate clinical decision in Crohn's disease. The minimum training required to gain competency, its accuracy and clinical utility requires evaluation. Methods In this pilot study, Crohn's disease activity and extent were assessed using POCUS (performed by a single gastroenterologist following the completion of 200 supervised scans), magnetic resonance enterography (MRE) and ileo‐colonoscopy. The presence of complications was assessed by POCUS and MRE. Accuracy of POCUS was analysed with respect to MRE and ileo‐colonoscopy. Agreement between modalities was assessed using kappa coefficient. Results Forty‐two patients had a POCUS paired with MRE. Thirty‐eight patients had a POCUS paired with ileo‐colonoscopy. When compared to MRE, POCUS was accurate in the assessment of disease activity (sensitivity 87.5%, specificity 61.1%, ROC 0.74), extent (sensitivity 77.8%, specificity 83.3%, ROC 0.81) and complications (sensitivity 85.7%, specificity 94.3%, ROC 0.90). Agreement between POCUS and MRE was moderate (kappa estimates 0.50, P < 0.001, 0.61, P < 0.001 and 0.76, P < 0.001) for disease activity, extent and complications, respectively. When compared to ileo‐colonoscopy, POCUS was accurate in the assessment of disease activity (sensitivity 72%, specificity 86%, ROC 0.79) and extent (sensitivity 85.7%, specificity 86%, ROC 0.86). For POCUS and ileo‐colonoscopy, kappa estimates were 0.55, P < 0.001 for disease activity and 0.62, P < 0.001 for disease extent. Conclusion POCUS performed by a gastroenterologist after completion of limited training is accurate for assessing Crohn's disease activity, extent and the presence of complications.

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Comparative Acceptability and Perceived Clinical Utility of Monitoring Tools

Abstract: Among the IBD monitoring tools, endoscopy demonstrated the lowest acceptability supporting the development of alternative modalities. Patients' information and examination conditions should be improved to ensure proper monitoring adherence.

Cited by 178 publications

References 49 publications

Gastrointestinal ultrasound in inflammatory bowel disease care: Patient perceptions and impact on disease‐related knowledge

Gastrointestinal ultrasound in inflammatory bowel disease care: Patient perceptions and impact on disease‐related knowledge

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

Accuracy of point‐of‐care intestinal ultrasound for Crohn's disease

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