Understanding the learning curve of intestinal ultrasound in inflammatory bowel disease: A comparative study between novice, regular and expert

Background

Intestinal ultrasound (IUS) has emerged as a valuable tool for monitoring inflammatory bowel disease (IBD), but its reliability depends on the technical skills of the operator.

Aims

This study aimed to assess the IUS learning curve of a novice briefly trained to get him familiarized with the ultrasound machine and normal/abnormal IUS images, and a gastroenterologist with formal general ultrasound training and regular IUS experience (> 200 exams), using an expert radiologist as the gold standard.

Methods

The ULTRA-IBD study was a single-center, prospective study involving 50 consecutive IBD patients. Three successive IUS examinations were performed on each patient by the 3 operators. Inter-rater agreement on IUS disease activity was calculated using the intraclass correlation coefficient.

Results

The experienced gastroenterologist demonstrated consistently good agreement with the radiologist throughout the study, while the novice failed to go beyond poor agreement after 50 examinations, although a faster learning curve was observed in patients without history of IBD surgery.

Conclusion

These findings highlight the difficulty of the technical performance of IUS rather than its interpretation. Comprehensive ultrasound training beforehand and between 50 and 200 examinations of experience are necessary before embarking on IUS.