Su1887 POINT-OF-CARE BOWEL ULTRASOUND FOR DETECTING ILEO-COLONIC INFLAMMATION IN CROHN'S DISEASE.

Abstract Background A ‘treat-to-target’ strategy with close monitoring of intestinal inflammation is recommended in Crohn’s disease (CD). Bowel ultrasound (US) is a non-invasive, point-of-care tool to assess CD activity and severity. However, no clear US-based parameters of activity have been identified by using magnetic resonance imaging (MRI) and colonoscopy together as a reference standard. We aimed to investigate whether US parameters could be able to measure CD activity and severity, comparing with the MaRIA and the SES-CD scores. Methods Ileal and/or colonic CD consecutive patients were prospectively assessed by CS, MRE and bowel US. Bowel wall thickening (mm), bowel wall-flow at colour Doppler (BWF: 0 absent; 1 present), bowel wall pattern (BWP: 0 normal; 1 hypoechogenic; 2 hyperchogenic; 3 lost), presence of mesenteric lymph nodes (0 absent; 1 present) and mesenteric hypertrophy (0 absent; 1 present), evaluated at bowel US were compared with CS+MRE findings as a reference standard. Activity was defined by an SES-CD score>2 and/or a MaRIA score>7). Results Sixty CD patients were prospectively enrolled (37% with ileal localisation, 15% with colonic localisation and 48% with ileocolonic localisation). Thirty patients had endoscopically active CD, 34 had radiologically active disease, 37 (62%) had active disease assessed at CS or MRE (SES-CD > 2 or MaRIA score >7 in at least one segment). BWT, presence of BWF, hypoechogenic or lost BWP significantly correlated with endoscopic and radiological activity (OR 4.51, 33.75, and 2.74 respectively, all p < 0.001). The multivariable analysis identified only BWT (per 1-mm increase, OR: 6.56, 95% CI 1.25–34.44, p = 0.026) as an independent predictor for disease activity. The cut-off value of 4.4 mm BWT was identified to distinguish active vs. non-active disease (AUROC 0.905, Sensitivity 81%, Specificity 96%). A significant correlation was found between BWT and MaRIA and SES-CD score (r = 0.768, 95% CI 0.662–0.868, p < 0.0001; r = 0.602, 95% CI 0.409–0.743; p < 0.0001; respectively). Conclusion Bowel US is able to assess and measure disease activity in ileocolonic CD in real-time. BWT correlated very well with the MaRIA score and the SES-CD score. Further studies are needed to confirm these findings and to demonstrate the role of point-of-care US in CD management.

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Clinical utility of small bowel ultrasound assessment of Crohn’s disease in adults: a systematic scoping review

Frontline Gastroenterology ◽

10.1136/flgastro-2021-101897 ◽

2021 ◽

pp. flgastro-2021-101897

Author(s):

Shellie Jean Radford ◽

Chris Clarke ◽

Bethany Shinkins ◽

Paul Leighton ◽

Stuart Taylor ◽

...

Keyword(s):

Crohn’S Disease ◽

Small Bowel ◽

Crohn's Disease ◽

Clinical Decision Making ◽

Imaging Modality ◽

Point Of Care ◽

Clinical Decision ◽

Search Terms ◽

The Uk ◽

Bowel Ultrasound

BackgroundUltrasound (US) is an alternative to magnetic resonance enterography, and has the potential to significantly reduce waiting times, expedite clinical decision-making and improve patient experience. Point of care US is an advantage of the US imaging modality, where same day scanning, interpretation and treatment decisions can be made.AimTo systematically scope the literature on point of care US use in small bowel Crohn’s disease, generating a comprehensive list of factors relating to the current understanding of clinical utility of this imaging modality.MethodsSearches included MEDLINE, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, clinicaltrial.gov,‘TRIP’ and Epistemonikos. Reference lists of included studies were hand searched. Search terms were searched for as both keywords and subject headings (MeSH) as appropriate. Searches were performed with the ‘suggested search terms’ and ‘explode’ selection, and restricted to ‘human’, ‘adult’ and ‘English language’ publications. No date limits were applied to be as inclusive as possible. Two investigators conducted abstract and full-text review. No formal quality appraisal process was undertaken; however, quality of sources was considered when reporting findings. A narrative synthesis was conducted.ResultsThe review included 42 sources from the UK, Europe, Japan, Canada and the USA. Small bowel ultrasound (SBUS) has been shown to be as accurate in detecting the presence of small bowel Crohn’s disease, is quicker, safer and more acceptable to patients, compared with magnetic resonance enterography. SBUS is used widely in central Europe and Canada but has not been embraced in the UK. Further research considering economic evaluation, clinical decision-making and exploration of perceived barriers to future implementation of SBUSs is required.

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Predictive value of bowel ultrasound in Crohn’s disease

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2021.04.040 ◽

2021 ◽

Author(s):

Xiaoying Huang ◽

Xiaofei Li

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Predictive Value ◽

Bowel Ultrasound

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Predictive value of bowel ultrasound in Crohn’s disease: a 12-month prospective study Reply to: Dr Xiaofei’s Letter

Clinical Gastroenterology and Hepatology ◽

10.1016/j.cgh.2021.05.036 ◽

2021 ◽

Author(s):

Mariangela Allocca ◽

Silvio Danese

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Prospective Study ◽

Predictive Value ◽

Bowel Ultrasound

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Abdominal bowel ultrasound can predict the risk of surgery in Crohn's disease: Proposal of an ultrasonographic score

Scandinavian Journal of Gastroenterology ◽

10.1080/00365520802705992 ◽

2009 ◽

Vol 44 (5) ◽

pp. 585-593 ◽

Cited By ~ 44

Author(s):

Caterina Rigazio ◽

Elena Ercole ◽

Cristiana Laudi ◽

Marco Daperno ◽

Alessandro Lavagna ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Ultrasound

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Role of bowel ultrasound in the management of postoperative Crohn's disease

World Journal of Gastrointestinal Pathophysiology ◽

10.4291/wjgp.v5.i4.457 ◽

2014 ◽

Vol 5 (4) ◽

pp. 457 ◽

Cited By ~ 6

Author(s):

Elena Ercole

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Bowel Ultrasound

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P465 Therapeutic drug monitoring in Crohn’s disease patients, a comparison between homogeneous mobility shift assay and point of care method

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz203.594 ◽

2020 ◽

Vol 14 (Supplement_1) ◽

pp. S412-S412

Author(s):

G Bodini ◽

M G Demarzo ◽

A Djahandideh ◽

I Baldissarro ◽

E Savarino ◽

...

Keyword(s):

Crohn’S Disease ◽

Therapeutic Drug Monitoring ◽

Crohn's Disease ◽

Drug Concentration ◽

Drug Monitoring ◽

Point Of Care ◽

Therapeutic Drug ◽

Serum Drug Concentration ◽

Disease Relapse

Abstract Background Therapeutic Drug Monitoring (TDM) is a useful tool to help physicians managing patients with Inflammatory Bowel Disease treated with anti-tumour necrosis factor (TNF) drugs. Different techniques are available to evaluate serum drug concentration (TL), However, these techniques are time-consuming. A point-of-care (POC) method has been proposed to evaluate drug TL and overcome the limitations inherent to other methodologies. Our aim was to evaluate the capability of POC to discriminate between IBD relapse and remission and to evaluate the concordance of drug TL measured with POC and HMSA Methods We analysed with Quantum BlueÒ (Buhlmann Laboratories AG, Schonenbuch, Switzerland) (POC) 200 Adalimumab (ADA) and 200 Infliximab serum samples of 46 Crohn’s disease (CD) patients previously assessed with HMSA. Blood samples were drawn at standardised time points during anti-TNF treatment (2, 6, and every 8 weeks), before anti-TNF administration. Disease activity was assessed by the Harvey–Bradshaw Index (HBI, remission defined by HBI<5). Results We evaluated 46 CD patients responders to anti-TNF induction with ADA (n = 25, 54.3%) and IFX (n = 21, 45.6%) with a median follow-up of 83 weeks (range 16–144 weeks). At week 16, median ADA TL of patients in remission were significantly higher as compared with patients in disease relapse using both HMSA [12.7 μg/ml (range, 8.9–23.6 μg/ml) vs. 6.6 μg/ml (range, 0.7–9.6 μg/ml), p = 0.0001] and POC [17.8 μg/ml (range 7.6–35.0 μg/ml) vs. 9.8 μg/ml (range 5.8–11.4 μg/ml), p = 0.0003]. The concordance between the two different techniques has been assessed as 0.76 by Choen Kappa. Considering IFX TL, patients in remission had higher serum drug concentration using both HMSA [7.0 μg/ml (range, 0.0–21.8 μg/ml)] and POC [6.2 μg/ml (range 0.4–14.3 μg/ml)] as compared with patients who experienced disease relapse [HMSA, 0.1 μg/ml (range, 0.0–4.1 μg/ml), p = 0.019; POC, 0.45 μg/ml (range 0.4–3.3 μg/ml), p = 0.0072]. The concordance between the two different test for IFX TL was 0.81. We obtained similar results at the end of follow-up: median ADA TL was higher in remission than in disease relapse patients using both HMSA and POC [p = 0.001 and p = 0.0012] with a concordance of 0.75. Median IFX TL was higher in remission than in disease relapse patients using both HMSA and POC (p = 0.13 and p = 0.25) with a concordance of 0.70. Conclusion Both POC and HMSA are TL tests able to differentiate relapse and remission in IBD patients. The association between anti-TNF TL and disease status (remission/relapse) was better in ADA-treated patients rather than patients treated with IFX. Finally, we demonstrated a good concordance between HMSA and POC. Anti-drug antibody concentrations while available on HMSA were not available on POC

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