TBA (24S151)

Building from the Ground Up: A 1 Year Experience of Intestinal Ultrasound for IBD Patients(ORAL PRESENTATION)

Author(s)

L Kumar, H Dhaliwal, M Hanly, A Fennessy, M Hamzawi, H Mulcahy, F Donnellan, G Horgan, S O’Reilly, E McDermott, M Buckley, J Sheridan, G Cullen, G Doherty

Department(s)/Institutions

Department of Gastroenterology, St. Vincent’s University Hospital School of Medicine, University College Dublin

Introduction

Intestinal Ultrasound (IUS) is a non-invasive, accessible, and accurate tool in assessing disease activity and extent for patients with Inflammatory Bowel Disease (IBD). A previous study has demonstrated that IUS significantly reduces time to decision making in IBD management as well as reduces time to remission.

Aims/Background

To review IUS performance and its impact on treatment decision making since its introduction in our centre.

Method

A retrospective review of all IUS scans performed for IBD outpatients between March 2023 and March 2024 was conducted. Baseline demographics were obtained including age, gender, disease subtype, disease location, and surgical history. We collected information about the IUS scans performed including indications for scans, adequacy of sonographic views, presence of positive findings, and presence of complications (strictures, abscesses, fistulae etc.). We then proceeded to follow their outcomes (e.g. no change in management plan, treatment changes, if further evaluation was required, etc.) and assessed if IUS findings impacted the decisions made on the day.

Results

A total of 249 IUS scans for 218 patients were reviewed. 51.2% of patients were female and the median age was 39 years (ICR: 28-49). Most scans were performed on patients with Crohn’s Disease (82.7%, n=206) of which 181 (72.7% of total) had ileal involvement of their disease. 93 (n=37.3%) of scans were performed on patients with a previous surgical resection and 19 scans (n=7.6%) were performed on patients with stomas. The most common indications for IUS were ‘Assessing Disease Activity in Symptomatic Patients’ (50.2%, n=125), ‘Disease Surveillance in Asymptomatic Patients’ in (19.7%, n=49) and ‘Monitoring Response to Treatment’ (14.1%, n=35). Overall, 92% (n=229) produced adequate sonographic views and positive findings were seen in 63.5% (n=158) of scans. Disease activity was identified in 57.8% (n=144) of scans. IUS was deemed sufficient to decide on management outcomes in 75.9% (n=189) of cases. 24.1% (n=60) required further investigations before confirming a management plan (endoscopy for 31, imaging for 18, faecal calprotectin for 11). Treatment changes based on IUS findings were made in 27.7% (n=69/217). Of these, 10.1% (n=18/69) were given steroids, 31.9% (n=22/69) were dose optimized, 31.9% (n=22/69) changed their medication, and 10.1% (n=7/69) had treatment de-escalation.

Conclusions

IUS is an effective tool with a high index of confidence on decision-making for the management of IBD in our centre. Incorporating IUS in the decision-making process has the potential to not only reduce time to remission but also avoid other more invasive, less accessible, and more expensive investigative modalities.