Leveraging existing mid-end ultrasound machine for point-of-care intestinal ultrasound in low-resource settings: Prospective, real-world impact on clinical decision-making

Aliment Pharmacol Ther. 2024 Sep;60(5):633-647. doi: 10.1111/apt.18155. Epub 2024 Jul 8.

Abstract

Background: Point-of-care ultrasound (POCUS) has transformed inflammatory bowel disease (IBD) management, but the cost to purchase high-end equipment can be prohibitive.

Aim: To assess prospectively the feasibility of POCUS using pre-existing mid-end ultrasound equipment without incurring additional cost.

Methods: Consecutive IBD patients underwent POCUS with or without faecal calprotectin (FCP) using a mid-end ultrasound machine. If POCUS with or without FCP could not guide management, we performed additional ileocolonoscopy or cross-sectional imaging. We evaluated the impact of POCUS on IBD management and its correlation with ileocolonoscopy or cross-sectional imaging. We analysed pregnant, paediatric and post-operative patients separately.

Results: Among 508 patients with IBD, we analysed 419 (60.4% Crohn's disease [CD]; 61.3% male, age [years]: 36 [18-78]) undergoing 556 POCUS sessions. POCUS with or without FCP independently influenced clinical management in 42.8% of patients with CD and 49.7% with ulcerative colitis (UC). POCUS helped avoid colonoscopy in 51.4% of patients with CD and 51.8% with UC, and cross-sectional imaging in 38.1% of suspected active small bowel CD. In patients with additional diagnostics, POCUS-based decisions remained unchanged in 81.2% with CD and 85% with UC. Sensitivity and specificity of POCUS compared to ileocolonoscopy were 80% and 94.4% for CD and 80.8% and 92.8% for UC, respectively. Sensitivity and specificity compared to cross-sectional imaging were 87.2% and 87.5%, respectively.

Conclusion: POCUS using existing mid-end ultrasound equipment in low-resource settings influenced IBD clinical decision-making with excellent accuracy, often avoiding colonoscopy and cross-sectional imaging.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Clinical Decision-Making*
  • Colonoscopy / instrumentation
  • Colonoscopy / methods
  • Crohn Disease / diagnostic imaging
  • Feasibility Studies
  • Feces
  • Female
  • Humans
  • Inflammatory Bowel Diseases / diagnostic imaging
  • Leukocyte L1 Antigen Complex* / analysis
  • Male
  • Middle Aged
  • Point-of-Care Systems*
  • Pregnancy
  • Prospective Studies
  • Ultrasonography* / methods
  • Young Adult

Substances

  • Leukocyte L1 Antigen Complex