Considerations in Imaging Among Emergency Department Patients With Inflammatory Bowel Disease

Griffey, Richard T.; Fowler, Kathryn J.; Theilen, Andrew; Gutierrez, Alexandra

doi:10.1016/j.annemergmed.2016.04.010

Cited by 17 publications

(13 citation statements)

References 95 publications

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“…US allows for real-time imaging and assessment of bowel peristalsis, which is beneficial to patients who present with acute exacerbations and complications. It can be used at the bedside in both the outpatient and emergency department settings as point-of-care testing to help guide therapeutic management [28][29][30]. US is operator-dependent, and it can have limitations based on the institution's protocol, potentially leading to inter-observer variability.…”

Section: Resultsmentioning

confidence: 99%

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Gamboa

Molle-Rios

Anupindi

2019

Dig Dis

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Background: Inflammatory bowel disease (IBD) is a chronic relapsing disease that requires evaluation using multiple objective tools. In Europe, bowel ultrasound (US) is a widely accepted modality used for the management of patients with IBD; however, its use in North America has only recently emerged as a potential technique. Objectives: Our goal was to identify current practice patterns of pediatric gastroenterologists and radiologists using bowel US in patients with IBD and highlight perceived limitations to the widespread adoption of this modality in North America. Methods: A 14-question survey was e-mailed to the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition internet bulletin board composed of 3,058 subscribers from 51 countries; the Society of Pediatric Radiology listserv composed of 1,917 subscribers worldwide; and the Society of Chairs of Radiology at Children's Hospitals listserv. Descriptive summary statistics was used. Results: In North America, about one-quarter of gastroenterology and radiology participants reported using bowel US for IBD; over 3-fourths expressed an interest in using US more often. Bowel US was performed more frequently for Crohn's disease. Both groups agreed the main limitation to using bowel US was concern for inter-observer variability and operator-dependent factors; radiologists reported that other modalities are more effective to assess IBD, whereas gastroenterologists reported unfamiliarity with bowel US indications and techniques. Conclusions: Our data show there is significant interest among both radiologists and gastroenterologists in using bowel US. However, lack of education, insufficient training, and perceived high inter-observer variability among US technologists are limitations preventing the widespread adoption of US for IBD in North America.

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Section: Resultsmentioning

confidence: 99%

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Gamboa

Molle-Rios

Anupindi

2019

Dig Dis

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“…The ED evaluation of symptomatic CD patients frequently necessitates an APCT to identify clinically relevant complications such as fistulas, strictures, obstruction, perforation, and intraabdominal abscesses [1,4]. APCT imaging is typically warranted given the high rates of detecting serious CD complications ranging from 29-47% and the identification of intraabdominal abscesses in 9-18% of these ED encounters [4,[10][11][12]. There is an overall trend towards increased CT usage with concern for lifetime radiation exposure in this patient population [4].…”

Section: Discussionmentioning

confidence: 99%

“…IBD-related emergency department (ED) visits have continued to rise, therefore, emergency physicians (EPs) should remain aware of these life-threatening complications [2,3]. EPs often rely on computed tomography (CT) as a first-line imaging modality for ED evaluation, however, the cumulative lifetime radiation exposure for CD patients is highly concerning due to CT overutilization [4]. Ultrasonography (US) is an alternative non-invasive modality for the diagnosis of a multitude of CD complications (including fistulas, strictures, and intraabdominal abscesses), while maintaining indispensable advantages of widespread availability, lower cost, and avoidance of radiation exposure [5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Point-of-Care Ultrasound Diagnosis of a Crohn’s Disease-Related Intraabdominal Abscess in the Emergency Department

Rivera

Cabrera

Kalivoda

2021

Cureus

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The emergency department (ED) diagnosis of Crohn's disease (CD)-associated complications is typically established with abdominopelvic computed tomography imaging. Ultrasonography has been suggested as an effective alternative modality for diagnosing several CD complications, including intraabdominal abscesses. We report the identification of a CD-related intraabdominal abscess by emergency physician (EP)-performed point-of-care ultrasound (POCUS). This case highlights the feasibility of EPs integrating POCUS into the clinical decision-making for patients with inflammatory bowel disease in the ED.

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“…A recent review has claimed that ultrasonography should not be considered a first‐line imaging test in adults with CD presenting to the ED 16 . However, a previous case series describes the use of POCUS for the detection of all types of colitis in the ED, including one case suspicious for CD according to POCUS findings and later confirmed by pathology to be CD 17 .…”

Section: Discussionmentioning

confidence: 99%

Sonographic assessment of inflammatory bowel disease in the emergency department: A case series and review of the literature

Esterson

Alpert

Gabrieli

et al. 2020

J of Clinical Ultrasound

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The use of sonography for diagnosing inflammatory bowel disease (IBD) has been reported in the radiology literature but is not common practice in the hands of emergency physicians (EPs). We present a series of three cases where IBD was managed by an EP using point‐of‐care ultrasonography (POCUS), and discuss the sonographic features of IBD including bowel wall thickening, increased blood flow on color Doppler, infiltration of surrounding fatty tissue, and presence of intraperitoneal fluid. Complications such as bowel strictures and peri‐colic abscess are also described. We suggest that the use of POCUS for the assessment of IBD patients in the ED may expedite both diagnosis and treatment, as well as minimize the use of additional imaging.

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Considerations in Imaging Among Emergency Department Patients With Inflammatory Bowel Disease

Cited by 17 publications

References 95 publications

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Underutilization of Bowel Ultrasound in North America in Children with Inflammatory Bowel Disease

Point-of-Care Ultrasound Diagnosis of a Crohn’s Disease-Related Intraabdominal Abscess in the Emergency Department

Sonographic assessment of inflammatory bowel disease in the emergency department: A case series and review of the literature

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