Clinical and environmental impact of intestinal ultrasound for inflammatory bowel disease: a tertiary centre experience in Southeast Asia.

Abstract

Objectives: Inflammatory bowel disease (IBD) is a chronic relapsing disease primarily affecting the gastrointestinal tract, comprising mainly of ulcerative colitis and Crohn's disease. Intestinal ultrasound (IUS) evaluates transmural healing, which is associated with better clinical outcomes. The aims of this study were to determine the influence of IUS on clinical management decisions and evaluate cost and carbon emission reductions when colonoscopies and magnetic resonance enterography (MRE) were avoided.

Methods: Eligible patients 18 years and older with established diagnosis of IBD within nine months. Patients seen in IBD outpatient clinics were offered IUS and followed up within two weeks, with evaluation of whether they were in clinical, biochemical and/or transmural remission. We determine clinical, biochemical and sonographic concordance for each IUS assessment and subsequent impact on clinical management.

Results: Out of 60 IUS assessments for 48 unique patients, 38 (63.3%) and 19 (31.7%) were in clinical and transmural remission, respectively. Of the 38 in clinical remission, 18 (47.4%) were in transmural remission. All but one with clinically active disease were not in transmural remission. There was moderate correlation between clinical and transmural remission. Discordant IUS findings were significantly associated with therapy escalation; 63.3 - 65% of patients who underwent IUS avoided endoscopy/MRE. Total cost savings amounted to US$ 92,069; total reduction in carbon emissions was 2752 kg CO₂e.

Conclusion: IUS is a valuable, cost effective and environmentally friendly investigation superior to MRE and endoscopy in evaluating transmural disease and has the potential to alter clinical decisions based on detection of transmural activity.