Johan F K F Ilvemark1, Tawnya Hansen2, Thomas M Goodsall3,4, Jakob B Seidelin1, Heba Al-Farhan5, Mariangela Allocca6,7, Jakob Begun8, Robert V Bryant9, Dan Carter10, Britt Christensen11, Marla C Dubinsky12, Krisztina B Gecse13, Torsten Kucharzik14, Cathy Lu15, Christian Maaser16, Giovanni Maconi17, Kim Nylund18,19, Carolina Palmela20, Stephanie R Wilson21, Kerri Novak15, Rune Wilkens22,23. 1. Department of Gastroenterology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark. 2. Department of Medicine, Section Gastroenterology, University of Manitoba, Manitoba, MN, Canada. 3. Department of Gastroenterology, John Hunter Hospital, Newcastle, NSW, Australia. 4. Faculty of Health Sciences, School of Medicine, University of Adelaide, Adelaide, SA, Australia. 5. Department of Gastroenterology, Department of Internal Medicine, Al Amiri Hospital, Kuwait City, Kuwait. 6. IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy. 7. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy. 8. Mater Research Institute, University of Queensland, Brisbane, QLD, Australia. 9. Department of Gastroenterology, Queen Elizabeth Hospital, Adelaide, SA, Australia. 10. Department of Gastroenterology, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel. 11. Department of Gastroenterology, TRoyal Melbourne Hospital, Melbourne, VIC, Australia. 12. Department of Pediatrics, Susan and Leonard Feinstein IBD Clinical Center, Icahn School of Medicine, New York, NY, USA. 13. Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, The Netherlands. 14. Department of Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany. 15. Division of Gastroenterology and Hepatology, Department of Medicine. University of Calgary, Calgary, AB, Canada. 16. Outpatients Department of Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany. 17. Gastroenterology Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Milan, Italy. 18. National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway. 19. Department of Clinical Medicine, University of Bergen, Bergen, Norway. 20. Division of Gastroenterology, Surgical Department, Hospital Beatriz Angelo, Loures, Portugal. 21. Department of Radiology and Medicine, University of Calgary, Calgary, AB, Canada. 22. Gastrounit, Division of Medicine, Hvidovre University Hospital, Copenhagen, Denmark. 23. Copenhagen Centre for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Copenhagen, Denmark.
Abstract
BACKGROUND AND AIMS: No consensus exists on defining intestinal ultrasound response, transmural healing, or transmural remission in inflammatory bowel disease, nor clear guidance for optimal timing of assessment during treatment. This systematic review and expert consensus study aimed to define such recommendations, along with key parameters included in response reporting. METHODS: Electronic databases were searched from inception to July 26, 2021, using pre-defined terms. Studies were eligible if at least two intestinal ultrasound [IUS] assessments at different time points during treatment were reported, along with an appropriate reference standard. The QUADAS-2 tool was used to examine study-level risk of bias. An international panel of experts [n = 18] rated an initial 196 statements [RAND/UCLA process, scale 1-9]. Two videoconferences were conducted, resulting in additional ratings of 149 and 13 statements, respectively. RESULTS: Out of 5826 records, 31 full-text articles, 16 abstracts, and one research letter were included; 83% [40/48] of included studies showed a low concern of applicability, and 96% [46/48] had a high risk of bias. A consensus was reached on 41 statements, with clear definitions of IUS treatment response, transmural healing, transmural remission, timing of assessment, and general considerations when using intestinal ultrasound in inflammatory bowel disease. CONCLUSIONS: Response criteria and time points of response assessment varied between studies, complicating direct comparison of parameter changes and their relation to treatment outcomes. To ensure a unified approach in routine care and clinical trials, we provide recommendations and definitions for key parameters for intestinal ultrasound response, to incorporate into future prospective studies.
BACKGROUND AND AIMS: No consensus exists on defining intestinal ultrasound response, transmural healing, or transmural remission in inflammatory bowel disease, nor clear guidance for optimal timing of assessment during treatment. This systematic review and expert consensus study aimed to define such recommendations, along with key parameters included in response reporting. METHODS: Electronic databases were searched from inception to July 26, 2021, using pre-defined terms. Studies were eligible if at least two intestinal ultrasound [IUS] assessments at different time points during treatment were reported, along with an appropriate reference standard. The QUADAS-2 tool was used to examine study-level risk of bias. An international panel of experts [n = 18] rated an initial 196 statements [RAND/UCLA process, scale 1-9]. Two videoconferences were conducted, resulting in additional ratings of 149 and 13 statements, respectively. RESULTS: Out of 5826 records, 31 full-text articles, 16 abstracts, and one research letter were included; 83% [40/48] of included studies showed a low concern of applicability, and 96% [46/48] had a high risk of bias. A consensus was reached on 41 statements, with clear definitions of IUS treatment response, transmural healing, transmural remission, timing of assessment, and general considerations when using intestinal ultrasound in inflammatory bowel disease. CONCLUSIONS: Response criteria and time points of response assessment varied between studies, complicating direct comparison of parameter changes and their relation to treatment outcomes. To ensure a unified approach in routine care and clinical trials, we provide recommendations and definitions for key parameters for intestinal ultrasound response, to incorporate into future prospective studies.
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