POINT-OF-CARE INTESTINAL ULTRASOUND ENHANCES DECISION-MAKING IN CROHN’S DISEASE PATIENT VISITS BUT NOT ULCERATIVE COLITIS, AND IS PREFERRED BY PATIENTS FOR DISEASE MONITORING

Introduction: Point-of-care intestinal ultrasound (IUS) is a non-invasive, accurate inflammatory bowel disease (IBD) monitoring tool. As IUS uptake grows and monitoring strategies become more complex, understanding the impact of IUS on clinical decision-making and monitoring preferences is needed. We aimed to assess the impact of IUS on decision-making during visits and patient preferences for disease monitoring across two academic IBD IUS centers.

Methods: Adults with Crohn’s disease (CD) and ulcerative colitis (UC) seen for a routine visit between 8/23/23 and 11/15/23 were recruited for participation. Patients were selected to undergo IUS or not at the discretion of their provider. Patients completed a survey featuring the Manitoba IBD Index, Patient-Reported Outcomes (PRO2), Patient Activation Measure (PAM-13), Morisky Medication Adherence Scale (MMAS-4), and 5-point Likert scales for comparison of disease monitoring tools. Review of electronic medical records was performed to assess demographics, IBD history, prior experience with IUS, physician global assessment (PGA), IUS findings, and medication changes immediately following the visit. Primary outcome was the association of medication changes in IUS and non-IUS visits. Secondary outcome was patient-reported preferences for disease monitoring. Data were analyzed using descriptive statistics and univariate analyses tested associations.

Results: Of 145 participants (97 (67%) CD, 48 (33%) UC, 120 (83%) on biologic or small molecule drug therapy; Table 1), 99 (68%) had ≥1 IUS (IUS cohort) while 46 (32%) had 0 IUS (non-IUS cohort). IUS cohort patients had lower rates of inactive disease (43/99 (43%) vs 38/46 (83%), p<0.001), and higher rates of mildly active (27/99 (27%) vs 5/46 (11%), p=0.03) and moderately active (16/99 (16%) vs 2/46 (4%), p=0.046) disease. IUS cohort CD patients were significantly more likely to undergo medication escalation vs non-IUS cohort CD patients (13/66 (20%) vs 1/31 (3%), p=0.03), with no differences seen in IUS vs non-IUS cohort UC patients (8/33 (24%) vs 5/15 (33%), p=0.53). IUS cohort patients expressed a strong preference for IUS (63/99, 65%) when comparing monitoring tools (Figure 1), with 64/99 (65%) reporting no discomfort. 93/145 (64%) patients expressed the strongest confidence in colonoscopy, but IUS cohort patients expressed stronger confidence in IUS (42/99; 42%) vs blood work (35/99; 35%), stool studies (31/99; 31%), and other cross-sectional imaging (28/99; 28%).

Conclusions: Point-of-care IUS can enhance treatment decision-making during CD patient visits but may have less value in UC patient visits. Patients favored IUS compared to other disease monitoring modalities when considering preference, usefulness, and comfort. Further studies are ongoing to assess the impact of IUS on shared understanding, patient activation, and medication adherence.