P1018 - Diagnostic Accuracy of Bowel Ultrasonography in Monitoring Inflammatory Bowel Disease: An Updated Systematic Review and Meta-Analysis

Hareesha Rishab Bharadwaj, ¹, Harshita Malik, MBBS², Sneh Sonaiya, MD, MPH, MBA³, Hassam Ali, MD⁴, Sheza Malik, MD⁵, Saqr Alsakarneh, MD, MSc⁶, Fariha Hasan, MD⁷, Omar Al Ta’ani, MD⁸, Umar Hayat, MD⁹, Priyal Dalal, MD¹⁰, Muhtasim Fuad, MD¹¹, Muhammad YN. Chaudhary, MBChB¹², Dhruv Gandhi, MD¹³, Dushyant S. Dahiya, MD¹⁴
1The University of Manchester, Manchester, England, United Kingdom; 2Kasturba Medical College Manipal, Narela, Delhi, India; 3Kirk Kerkorian School of Medicine at the University of Nevada Las Vegas, Las Vegas, NV; 4East Carolina University/Brody School of Medicine, Greenville, NC; 5Emory University, Atlanta, GA; 6Mayo Clinic, Rochester, MN; 7Cooper University Hospital, Camden, NJ; 8Department of Internal Medicine, Allegheny Health Network, Pittsburgh, Pennsylvania, USA, Pittsburgh, PA; 9Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA; 10School of Medicine, University of Central Lancashire, Preston, UK,, Preston, England, United Kingdom; 11Indiana University Southwest Internal Medicine Residency, Evansville, Indiana, USA,, Evansville, IN; 12Indiana University Southwest Internal Medicine Residency Program, Evansville, IN; 13St Francis Medical Center, Monroe, LA, Mumbai, Maharashtra, India; 14University of Kansas School of Medicine, Kansas City, KS

Introduction: Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis
(UC), requires regular monitoring to guide treatment. While colonoscopy is the gold
standard, its invasiveness limits its routine use. Bowel ultrasonography (BUS) has
emerged as a noninvasive, accessible imaging tool for IBD. The objective of this study
was to evaluate the diagnostic accuracy of BUS in detecting IBD activity compared to
colonoscopy, with detailed assessment of sensitivity, specificity, and performance
across BUS modalities.

Methods: A systematic review and meta-analysis included 37 studies assessing BUS
modalities—standard BUS, color Doppler, small intestine contrast ultrasonography
(SICUS), and contrast-enhanced ultrasound (CEUS). Pooled sensitivity, specificity,
diagnostic odds ratios (DOR), and likelihood ratios were calculated, with subgroup
analyses by modality and IBD subtype.

Results: The overall pooled sensitivity and specificity of BUS for IBD were 90.0% and 83.5%,
respectively. Among modalities, SICUS demonstrated the highest sensitivity (95.0%),
while BUS with color Doppler showed the highest specificity (85.1%). CEUS achieved
the strongest diagnostic power, with a DOR of 75.52. Condition-specific analyses
revealed that BUS was most effective for detecting postoperative CD recurrence
(sensitivity 91.9%, DOR 61.9), with CD evaluations showing the lowest false-positive
(13.9%) and false-negative (8.1%) rates. Meta-regression identified side-to-side
anastomosis as a significant predictor of improved diagnostic performance (p = 0.003).
Across all subgroups, BUS consistently showed robust positive and negative likelihood
ratios, supporting its use as a reliable noninvasive diagnostic tool. Figure 1
demonstrates the HSROC curve for BUS.

Discussion: BUS offers high diagnostic accuracy for IBD, particularly postoperative CD, with
modality-specific strengths: SICUS excels for screening, color Doppler BUS for
confirmation, and CEUS for overall diagnostic power. Future research should focus on
protocol standardization, head-to-head comparisons with MRI and CT enterography,
and evaluating BUS’s integration into long-term IBD management.


Figure: Figure 1: HSROC curve for bowel ultrasonography.

Disclosures:
Hareesha Rishab Bharadwaj indicated no relevant financial relationships.
Harshita Malik indicated no relevant financial relationships.
Sneh Sonaiya indicated no relevant financial relationships.
Hassam Ali indicated no relevant financial relationships.
Sheza Malik indicated no relevant financial relationships.
Saqr Alsakarneh indicated no relevant financial relationships.
Fariha Hasan indicated no relevant financial relationships.
Omar Al Ta’ani indicated no relevant financial relationships.
Umar Hayat indicated no relevant financial relationships.
Priyal Dalal indicated no relevant financial relationships.
Muhtasim Fuad indicated no relevant financial relationships.
Muhammad Chaudhary indicated no relevant financial relationships.
Dhruv Gandhi indicated no relevant financial relationships.
Dushyant Dahiya indicated no relevant financial relationships.

Hareesha Rishab Bharadwaj, ¹, Harshita Malik, MBBS², Sneh Sonaiya, MD, MPH, MBA³, Hassam Ali, MD⁴, Sheza Malik, MD⁵, Saqr Alsakarneh, MD, MSc⁶, Fariha Hasan, MD⁷, Omar Al Ta’ani, MD⁸, Umar Hayat, MD⁹, Priyal Dalal, MD¹⁰, Muhtasim Fuad, MD¹¹, Muhammad YN. Chaudhary, MBChB¹², Dhruv Gandhi, MD¹³, Dushyant S. Dahiya, MD¹⁴. P1018 - Diagnostic Accuracy of Bowel Ultrasonography in Monitoring Inflammatory Bowel Disease: An Updated Systematic Review and Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.