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

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.