St-Pierre Joëlle, Delisle Maxime, Kheirkhahrahimabadi Hengameh, Goodsall Thomas M, Bryant Robert V, Christensen Britt, Vaughan Rose, Al-Ani Aysha, Ingram Richard J M, Heatherington Joan, Carter Dan, Lu Cathy, Ma Christopher, Novak Kerri L
IBD Unit, Division of Gastroenterology and Hepatology, Department of Medicine, University of Calgary, Alberta, Canada.
Division of Rheumatology, Department of Medicine, University of Calgary, Alberta, Canada.
Crohns Colitis 360. 2023 Sep 21;5(4):otad050. doi: 10.1093/crocol/otad050. eCollection 2023 Oct.
Patients with inflammatory bowel disease (IBD) require accessible, timely, and noninvasive strategies to monitor disease. The aim was to assess the integration of intestinal ultrasound (IUS) on decision-making and endoscopy utilization in a standardized care pathway.
This prospective, multicenter, international, observational cohort study included patients seen within a centralized model for IBD care was conducted during the COVID pandemic. Patients were evaluated with IUS alone or in combination with an in-clinic, unsedated sigmoidoscopy. Demographic, clinical, laboratory, and imaging data, clinical decisions, and need for urgent endoscopy, hospitalization, and surgeries were recorded.
Of the 158 patients included, the majority had an established diagnosis of Crohn's disease ( = 123, 78%), and 47% ( = 75) of patients were on biologic therapy. IUS identified active inflammation in 65% ( = 102) of patients, and strictures in 14% ( = 22). Fecal calprotectin levels correlated with inflammation detected on IUS (median of 50 μg/g [Q1-Q3: 26-107 μg/g] without inflammation and 270 μg/g [Q1-Q3: 61-556 μg/g] with inflammation; = 0.0271). In the majority of patients, clinical assessment with IUS led to an acute change in IBD-specific medications (57%, = 90) and avoided or delayed the need for urgent endoscopy (85%, = 134). Four patients were referred for urgent surgical consultation.
Point-of-care IUS used in a flare clinic pathway is a useful strategy to improve effective IBD care delivery and to assist in therapeutic management decisions, in many cases avoiding the acute need for endoscopy.
炎症性肠病（IBD）患者需要可及、及时且无创的疾病监测策略。本研究旨在评估肠道超声（IUS）在标准化护理路径中对决策制定和内镜检查利用的整合情况。
这项前瞻性、多中心、国际性观察队列研究纳入了在新冠疫情期间采用集中式IBD护理模式就诊的患者。患者单独接受IUS检查，或联合门诊非镇静乙状结肠镜检查。记录患者的人口统计学、临床、实验室和影像学数据、临床决策以及紧急内镜检查、住院和手术需求。
纳入的158例患者中，大多数已确诊为克罗恩病（n = 123，78%），47%（n = 75）的患者接受生物治疗。IUS在65%（n = 102）的患者中发现了活动性炎症，14%（n = 22）的患者存在狭窄。粪便钙卫蛋白水平与IUS检测到的炎症相关（无炎症时中位数为50μg/g [四分位间距：26 - 107μg/g]，有炎症时为270μg/g [四分位间距：61 - 556μg/g]；P = 0.0271）。在大多数患者中，IUS临床评估导致IBD特异性药物急性改变（57%，n = 90），并避免或延迟了紧急内镜检查的需求（85%，n = 134）。4例患者被转诊进行紧急手术会诊。
在发作诊所路径中使用即时护理IUS是改善IBD有效护理提供和辅助治疗管理决策的有用策略，在许多情况下可避免急性内镜检查需求。
