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

Abstract

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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“… 5–7 Although interest in implementing IUS is increasing, actual use is currently limited. 8 , 9 A recent study found the assumed poor reliability and operator dependence as a predominant limiting factor. 8 However, data on the reliability of IUS and individual parameters are scarce.…”

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“…139 Although pediatric gastroenterologists are highly interested in applying IUS, the routine application in clinical practice is still limited due to a lack of education and insufficient training. 140 However, the abundance of pediatric gastroenterologists passing the IBUS training curriculum and implementing IUS in their IBD clinics recently increased. Hopefully, this indicates a paradigm change.…”