Original Title: Efectividad diagnóstica, eficiencia y perspectiva de pacientes y profesionales sobre la ecografía intestinal en la enfermedad inflamatoria intestinal

Authors' objectives: To assess the diagnostic effectiveness and cost-effectiveness of ultrasound for the diagnosis and follow-up of inflammatory bowel disease (IBD) as well as perception of patients and health professionals of this approach.

Authors' results and conclusions: Ten systematic reviews were identified on the diagnostic effectiveness of ultrasound in IBD, highlighting its role in disease screening and monitoring. Computed tomography (CT) was shown to have greater diagnostic accuracy in the initial diagnosis of IBD, followed by magnetic resonance imaging (MRI), while ultrasound was shown to have high specificity to rule out the disease, and is increasingly recognized as an accessible and safe alternative. In children, MRI is the most accurate technique to assess inflammatory activity, although ultrasound remains an option in settings where MRI is not available. In the context of Crohn’s disease, small intestinal contrast ultrasonography (SICUS) was shown to have a high sensitivity and specificity for the identification of strictures, abscesses, fistulae and inflammatory masses, with a similar performance to MRI for the assessment of inflammatory activity. MRI remains the gold standard for the identification of postoperative recurrence, although SICUS is a feasible option in settings with limited resources. Regarding the perspective of patients and professionals, 15 studies were analysed, including 5 based on health professionals, 3 on children and 7 on adult patients. Health professionals recognise the potential of ultrasound as a diagnostic tool, but they highlight barriers such as an insufficient training among professionals and variable accuracy depending on the operator’s experience. Both paediatric and adult patients prefer ultrasound as it is non-invasive and more comfortable than other tests, underling the importance of effective medical communication to enhance its acceptance. In terms of cost-effectiveness, one economic evaluation was identified suggesting that ultrasound may be more cost-effective that MRI for routine imaging of the small intestine, although the evidence is limited. Further economic evaluations should be conducted under routine clinical practice conditions to obtain more robust conclusions. Conclusions Intestinal ultrasound is a key diagnostic tool in IBD, and stands out as a safe, accessible, non-invasive, and radiation-free technique. It provides diagnostic accuracy comparable to CT and MRI in many clinical settings. In children, MRI remains the gold standard due to its greater diagnostic accuracy for the evaluation of disease activity and extent; however, young children may require sedation, which is a practical limitation. In this context, ultrasound emerges as a useful less-invasive complementary option. Regarding Crohn’s disease, the use of SICUS has shown to be useful for the diagnosis of strictures, especially in clinical practice. Continuous ultrasound remains the gold standard for the detection of postoperative recurrence, although there is currently no clear evidence supporting the superiority of MRI over ultrasound in this context. Intravenous contrast-enhanced ultrasound is occasionally used in the identification of inflammatory masses, such as phlegmons and abscesses; however, its routine use for assessing inflammatory activity is not widespread and has not consistently shown to provide added value in diagnostic performance. Health professionals highlight its usefulness in clinical practice, although they identify barriers such as insufficient training and limited resources. Patients, both adults and children, prefer less-invasive procedures, and underline the importance of good communication with health professionals for a good healthcare experience. The economic evidence retrieved is scarce but suggests that ultrasound may be more cost-effective than MRI for routine imaging of the small intestine in patients with Crohn’s disease. No economic studies were found regarding ulcerative colitis or comparing with CT. Further research is recommended assessing the efficiency of ultrasound in IBD under real world conditions within the Spanish National Health System.

Authors' methods: A systematic review of the literature was carried out to assess the diagnostic effectiveness and cost-effectiveness of intestinal ultrasound in IBD, as well as perceptions of this approach. The search was conducted in databases specialized in systematic reviews (Cochrane Library, International Health Technology Assessment Database), general biomedical databases (Medline, Embase), and sources of clinical practice guidelines (Guidelines International Network, Trip Database). Studies were also identified reporting economic evaluations, as well as the experience of patients and health professionals. Studies were selected by two independent reviewers using the Rayyan tool, applying predefined inclusion and exclusion criteria. The methodological quality of the studies was evaluated. Data were extracted using a structured form, organizing the information into evidence tables.

Project Status: Completed

Year Published: 2025

URL for published report: https://www.euskadi.eus/contenidos/informacion/osteba_publicacion/eu_def/adjuntos/E-25-09-Ecografia_intestinal.pdf

English language abstract: An English language summary is available

Publication Type: Mini HTA

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>