TOPLINE 

Within 5 years of integrating an intestinal ultrasound (IUS) service into an inflammatory bowel disease (IBD) care model , the use of endoscopy for assessing IBD activity fell by more than 50%. This reduction occurred despite an increase in clinic visits, and during the same period, the use of IUS rose steadily, exceeding 3000 IUS scans in total.

METHODOLOGY 

• Although endoscopy remains the primary method to assess and monitor disease activity in IBD, its use is often limited by cost, access, procedural risks, and patient acceptance, leading to the increased adoption of noninvasive tools, such as IUS.
• Researchers conducted a single-center retrospective analysis comparing the use of endoscopy for assessing disease activity in IBD across two 5-year periods: the pre-IUS era (2010-2014) and the IUS era (2015-2019).
• They reviewed 1746 patients in the pre-IUS era and 3080 patients in the IUS era and recorded the total number of lower gastrointestinal endoscopies (ileocolonoscopy or flexible sigmoidoscopy) performed to assess disease activity in patients with luminal Crohn’s disease or ulcerative colitis.
• IUS examinations were performed by accredited sonologists either at dedicated outpatient lists or during twice-weekly IBD clinic visits, with referrals made by clinic consultants who could choose among IUS, fecal calprotectin, or endoscopy.
• The primary objective was to compare the cumulative annual number of endoscopies performed for assessing IBD activity relative to the number of patients reviewed annually in IBD clinics during the pre-IUS and IUS eras.

TAKEAWAY 

• In the pre-IUS era, 576 endoscopies were performed for evaluating IBD activity (325 for Crohn’s disease and 251 for ulcerative colitis), and in the IUS era, 474 endoscopies were performed (264 for Crohn’s disease and 210 for ulcerative colitis).
• Following the introduction of IUS, the overall annual cumulative endoscopy rate declined from 33 per 100 patients in the pre-IUS era to 15 per 100 patients in the IUS era, representing a 53% reduction (incidence rate ratio [IRR], 0.47; 95% CI, 0.41-0.53; P < .001).
• Among patients with Crohn’s disease, the annual cumulative endoscopy rate decreased from 30 to 14 per 100 patients (IRR, 0.45; 95% CI, 0.38-0.53; P < .001), whereas among patients with ulcerative colitis, the rate declined from 37 to 17 per 100 patients (IRR, 0.46; 95% CI, 0.38-0.55; P < .001).
• During the IUS era, 3319 IUS examinations were performed among patients with IBD, of which 1467 (44 per 100 patients per year) were performed to evaluate active disease (1143 for Crohn’s disease and 324 for ulcerative colitis) and 1852 (55 per 100 patients per year) to confirm sonographic remission (1530 for Crohn’s disease and 322 for ulcerative colitis). 

IN PRACTICE

“While the causality of this association cannot be proven from our data, with IUS being performed for both assessment of disease activity and objective confirmation of clinical remission, the potential workflow and cost savings of reducing endoscopies for IBD disease activity may be significant. IUS has the potential to become the primary disease monitoring strategy in IBD,” the authors of the study wrote.

“This reduction in the use of endoscopy for IBD disease activity assessment may help to reduce endoscopy waiting lists by redirecting endoscopy use to other patient groups,” they added.

SOURCE 

The study was led by Grace S. Feng, Alfred Health in Melbourne, Australia. It was published online in the Journal of Crohn’s and Colitis.

LIMITATIONS 

The study was conducted at a single center, which may have introduced the potential for referral and selection bias. Extensive experience with IUS at the center may have limited the generalizability of the findings to settings where the technique was less available or less commonly used. The inclusion criteria were restricted to patients with Crohn’s disease or ulcerative colitis, and further demographic classification and analysis based on disease phenotype and severity and prior treatments were not conducted.

DISCLOSURES 

No funding sources were reported for this study. Some authors disclosed receiving conference fees and travel support, research funding, educational support, speaker fees, and consultancy fees and serving on advisory boards for various pharmaceutical and healthcare organizations.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.