Intestinal ultrasound in patients with suspected Crohn’s disease – results of a prospective evaluation by trainees

Abstract

Background and aims

Intestinal ultrasound (IUS) performed by experts is a valuable tool for the diagnostic work-up and monitoring of Crohn’s disease (CD). However, concern about insufficient training and perceived high inter-observer variability limit the adoption of IUS in CD. We examined the diagnostic accuracy of trainee-performed IUS in patients with suspected CD.

Method

Patients recruited to a prospective trial investigating the diagnostic accuracy of magnetic resonance enterocolonography (MREC) in patients with clinically suspected CD underwent IUS performed by trainees. The primary end-point was IUS per-patient sensitivity and specificity for ileocolonic CD determined by ileocolonoscopy.

Results

129 patients with clinically suspected CD and a complete IC and IUS were included in the analysis. IUS detected signs of CD in 49 cases (small bowel 31, colon 15, small bowel, and colon 3). The sensitivity and specificity for detection of ileocolonic CD by trainee performed IUS improved during the first to the second half of the study period from 57.1% (CI 34.0-78.2) to 73.1% (CI 52.2-88.4) and 76.5% (CI 58.8-89.3) to 89.7% (CI 72.6-97.8). The overall sensitivity and specificity of diagnosing CD with IUS were 65.4% (CI 50.9-78.0) and 80.5% (CI 69.9-88.7). There was no difference in diagnostic performance between IUS and MREC for the detection of CD.

Conclusion

Trainees improved during the study, and IUS performance in disease detection corresponded to expert-evaluated MREC.

Registered at ClinicalTrials.gov (NCT03134586).

Keywords:

• Crohn’s disease
• intestinal ultrasound
• magnetic resonance imaging
• diagnostic imaging

Acknowledgments

We thank Dr. Morten L. Halling for constructive feedback on the manuscript.

Disclosure statement of interest

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by grants from the Region of Southern Denmark, the Research Council Lillebaelt Hospital, and The Danish Colitis and Crohn’s Association, Colitis-Crohn Foreningen; Region Syddanmark; Sygehus Lillebælt.