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

• Published in: Alimentary pharmacology & therapeutics 2024-09, Vol.60 (5), p.633-647
• Main Authors: Pal, Partha, Mateen, Mohammad Abdul, Pooja, Kanapuram, Marri, Uday Kumar, Gupta, Rajesh, Tandan, Manu, Reddy, D. Nageshwar
• Format: Article
• Language: English
• Subjects: Colon; Colonoscopy; Crohn's disease; Decision making; Inflammatory bowel disease; Inflammatory bowel diseases; Intestine; Patients; Pediatrics; Small intestine; Ulcerative colitis; Ultrasonic imaging; Ultrasound
• ISSN: 0269-2813; 1365-2036; 1365-2036
• DOI: 10.1111/apt.18155

Summary 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. Utilising an existing mid‐end ultrasound, POCUS independently impacted IBD management in 45%, negating the need for colonoscopy and/or cross‐sectional imaging in 40%–50%. POCUS‐informed management decisions remained unaltered in 80% of cases post additional testing, exhibiting excellent agreement (≥85%).