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Is Handheld Ultrasound as Good as Conventional Ultrasound for Ulcerative Colitis Disease Assessment?

Bincy P. Abraham, MD, MS reviewing Rispo A, et al. J Crohns Colitis 2023 Feb 16.

Conventional intestinal ultrasound (IUS) is a point-of-care, noninvasive tool for assessing ulcerative colitis (UC) disease activity. Accurate readings have required conventional systems that can provide images of the layers of the bowel wall. Handheld intestinal ultrasound (HHIUS) has been emerging as a more portable tool for clinical assessment, but limited data exist regarding its utility for UC assessment.

In this prospectively enrolled one-year study at an inflammatory bowel disease center, 86 patients who underwent colonoscopy also had IUS and HHIUS within 7 days. IUS, using the Logiq 7 Pro ultrasound system (GE HealthCare) with both linear and convex probes, was performed by two experts with more than 10 years of experience and unaware of the HHIUS results. The HHIUS was performed with a dual probe Vscan (GE HealthCare) by two gastroenterologists with more than 6 years of experience and blind to the IUS results.

Comparing IUS and HHIUS, they provided comparable information regarding bowel wall thickness and bowel wall stratification, two important ultrasound findings used to assess disease activity. The HHIUS slightly underestimated colonic wall flow, but this was nonsignificant. Moreover, there was excellent agreement between the IUS and HHIUS scores when the Milan ultrasound criteria score, a validated tool for assessing UC disease activity, was used (k=0.86; P<.01). IUS was only more accurate than HHIUS for the detection of pericolic reactive lymph nodes (45% vs 21%; P<.01).

Comment:

This prospective comparative study provides comparable and correlated data between conventional and handheld IUS for patients with UC. Although more studies will be needed, those previously skeptical of HHIUS could consider using this as a portable tool, especially in patients who may not have access to a clinic for ultrasound assessment, where a provider can bring the machine to the patient. HHIUS could be particularly useful for hospitalized patients with UC as well. A similar study should be considered in Crohn’s disease, for which small bowel involvement and a comparison of both machines should be made.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Bincy P. Abraham, MD, MS

Bio and Disclosures

Citation(s):

Rispo A, Calabrese G, Testa A, et al. Hocus pocus: the role of handheld ultrasonography in predicting disease extension and endoscopic activity in ulcerative colitis. J Crohns Colitis 2023 Feb 16. (Epub ahead of print) (https://doi.org/10.1093/ecco-jcc/jjad024)