Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application

Abstract

Evolution of treatment targets in IBD has increased the need for objective monitoring of disease activity to guide therapeutic strategy. Although mucosal healing is the current target of therapy in IBD, endoscopy is invasive, expensive and unappealing to patients. GI ultrasound (GIUS) represents a non-invasive modality to assess disease activity in IBD. It is accurate, cost-effective and reproducible. GIUS can be performed at the point of care without specific patient preparation so as to facilitate clinical decision-making. As compared with ileocolonoscopy and other imaging modalities (CT and MRI), GIUS is accurate in diagnosing IBD, detecting complications of disease including fistulae, strictures and abscesses, monitoring disease activity and detecting postoperative disease recurrence. International groups increasingly recognise GIUS as a valuable tool with paradigm-changing application in the management of IBD; however, uptake outside parts of continental Europe has been slow and GIUS is underused in many countries. The aim of this review is to present a pragmatic guide to the positioning of GIUS in IBD clinical practice, providing evidence for use, algorithms for integration into practice, training pathways and a strategic implementation framework.

Usefulness of intestinal real‐time virtual sonography in patients with inflammatory bowel disease

“…Therefore, expertise is necessary for the assessment of intestinal lesions to overcome these obstacles . Although recently the International Bowel Ultrasound Group has proposed an internationally recognized education for learning intestinal US, such programs have not yet been widely available . We found that the time to scan the intestine was significantly shortened by using RVS in subjects without apparent intestinal diseases.…”

“…US is a noninvasive, radiation‐free, and inexpensive modality compared with CT, MRI, and endoscopy . Intestinal US has been reported useful for diagnosing of IBD and assessment of IBD disease activity . A recent meta‐analysis showed that US has a high diagnostic accuracy for detecting CD .…”

“…In fact, mapping of the exact anatomic location of the small intestine proximal to the ileocecal valve or anastomosis is really challenging. A special training program is necessary to acquire the sufficient skills to make correct assessments of intestinal damage in IBD patients, and such programs are not commonly provided . To date, regular use of transabdominal US for the assessment of intestinal lesions of IBD is limited to institutions where expert operators are engaged.…”

Gastrointestinal ultrasound in inflammatory bowel disease: experience from the Chinese IBD Elite Union

“…We read with great interest a recent review by Bryant et al 1 presenting a pragmatic guide of GI ultrasound (GIUS) in IBD clinical practice. We agree with the authors that the uptake of GIUS outside Europe has been slow and GIUS is underused in many countries.…”

“…First, gastroenterologist-performed ultrasound and point-of-care ultrasound should be encouraged, as has been successfully implemented in other chronic diseases. GIUS performed by gastroenterologist compared with radiologist could potentially provide more relevant information for management decision 1. Second, there is a need to establish standardised educational training pathways of GIUS.…”