Intestinal Ultrasonography as an Alternative to Fecal Calprotectin to Monitor Patients with Crohn’s Disease: Experience from a Novice Sonographer

Background While fecal calprotectin (Fcal) is now recommended, the positioning of intestinal ultrasonography (IUS) is still unknown to monitor patients with CD. Aims To assess the agreement between IUS performed by a novice sonographer and Fcal to detect active CD and to compare these two monitoring...

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Published in:	Digestive diseases and sciences Vol. 69; no. 9; pp. 3402 - 3412
Main Authors:	Mathieu, Kelly, Junda, Jérémy, Minet-Quinard, Régine, Coban, Dilek, Dodel, Marie, Pereira, Bruno, Buisson, Anthony
Format:	Journal Article
Language:	English
Published:	New York Springer US 01-09-2024 Springer Nature B.V
Subjects:	Adult Agreements Biochemistry Biomarkers - analysis Biomarkers - metabolism Crohn Disease - diagnostic imaging Crohn Disease - metabolism Cross-Sectional Studies Feces Feces - chemistry Female Gastroenterology Hepatology Humans Intestines - diagnostic imaging Leukocyte L1 Antigen Complex - analysis Leukocyte L1 Antigen Complex - metabolism Male Medicine Medicine & Public Health Middle Aged Oncology Original Article Prospective Studies Transplant Surgery Ultrasonic imaging Ultrasonography - methods Young Adult Fecal calprotectin Inflammatory bowel disease Monitoring Ultrasonography Crohn’s disease
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Summary:	Background While fecal calprotectin (Fcal) is now recommended, the positioning of intestinal ultrasonography (IUS) is still unknown to monitor patients with CD. Aims To assess the agreement between IUS performed by a novice sonographer and Fcal to detect active CD and to compare these two monitoring tools to determine the need for therapeutic escalation. Methods In this cross-sectional prospective study, we consecutively included CD patients ≥ 18 years-old with concomitant IUS and Fcal testing within 7 days. IUS was performed by a novice sonographer. The endpoints were the agreement between IUS and Fcal (> 150 µg/g) to detect active CD and the need for therapeutic escalation. Results Among 66 patients undergoing IUS, 56 patients had also Fcal testing. The agreement between IUS and Fcal to detect an active CD was 80.4% ( κ -coefficient = 0.536 ± 0.127). Fcal, IUS or both had respectively the following positive (76.9%[54.0–99.8], 70.0%[49.9–90.1], and 81.8%[59.0–100.0]) and negative (81.4%[69.8–93.0], 88.9%[78.6–99.2], and 80.0%[68.3–91.7]) predictive values to detect active CD requiring therapeutic escalation. Using a 10 points-acceptability numerical scale, IUS presented with a better acceptability than Fcal (9.5 ± 1.2 vs 8.0 ± 2.3, p < 0.0001). Contrary to the agreement with Fcal and the performances of IUS to identify the need for therapeutic escalation, the duration of IUS procedure decreased over time (correlation coefficient = − 0.54, p = 0.001) and plateaued between 15 and 20 min-long from the 24th procedure. Conclusion IUS and fecal calprotectin do not give the same information and could be complementary to monitor patients with CD. Graphical Abstract
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0163-2116 1573-2568 1573-2568
DOI:	10.1007/s10620-024-08548-w