Correlation of Point-of-Care Intestinal Ultrasound With Endoscopic Disease Severity in Crohn's Disease

Abstract

Background

Intestinal ultrasound is increasingly being used in the management of patients with inflammatory bowel disease (IBD). We aim to evaluate the accuracy of intestinal ultrasound in a point-of-care setting in India and compare it with ileo-colonoscopy, the current gold standard.

Methods

In this prospective observational study, consecutive patients with a diagnosis of Crohn's disease seen at initial presentation or follow-up were included. At the out-patient visit, clinical severity and biomarkers were documented, and point-of-care intestinal ultrasound was performed. Colonoscopy was performed within 1 week for all patients.

Results

A total of 254 patients with Crohn's disease who underwent ileo-colonoscopy were included in the study. The mean bowel wall thickness (BWT) in patients with normal endoscopy (SES-CD < 2) was 2.09 mm. The mean BWT in patients with mild, moderate to severe, and severe disease activity was 4.7, 5.23, and 6.25 mm, respectively. A threshold of 3.4 mm had the best ability to predict the presence of endoscopic disease activity, with a sensitivity of 93%, specificity of 90%, and AUC of 0.96 in this study. The presence of color Doppler signals had a sensitivity of 96.3% and specificity of 91.2% to predict the presence of endoscopic disease activity. Inflammatory fat and bowel wall stratification (BWS) had a higher odds ratio to predict more severe disease.

Conclusion

Point-of-care—intestinal ultrasound has good correlation with ileocolonoscopy and can be utilized to assess and monitor disease activity, which should facilitate real-time decision making in the management of patients with IBD.