P1195 - Feasibility of Intestinal Ultrasound in Pregnant Patients with IBD: A Safe and Reliable Modality for Disease Monitoring

Award: ACG Outstanding Research Award in the IBD Category

Award: ACG Presidential Poster Award

Oscar Noble, MD¹, Ana Paola Islas Guerra, MD¹, Hannah O'Neill, MD², Poojasree Pasupuleti, MS¹, Christopher Fan, MD³, Bincy Abraham, MD, MS, FACG⁴
1Houston Methodist Hospital, Division of Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Health / Houston Methodist Research Institute, Department of Medicine, Houston, TX; 2Houston Methodist-Weill Cornell Graduate School of Medical Sciences, Houston, TX; 3Houston Methodist Hospital, Division of Gastroenterology and Hepatology, Lynda K. and David M. Underwood Center for Digestive Health / Houston Methodist Research Institute, Department of Medicine / Weill Cornell Medical College, Cornell University, Houston, TX; 4Division of Gastroenterology & Hepatology, Houston Methodist-Weill Cornell, Houston, TX

Introduction: Intestinal ultrasound (IUS) is a non-invasive tool for assessing inflammatory bowel disease (IBD) and is particularly valuable in pregnant patients where blood markers may be unreliable and endoscopy or cross-sectional imaging are frequently avoided. IUS enables real-time evaluation of bowel wall thickness and vascularity. However, existing literature highlights inherent limitations, including reduced sensitivity for rectal assessment and reduced visualization of the sigmoid colon and terminal ileum, particularly as gestational age advances.

Methods: All IUS performed in pregnant patients with IBD were retrospectively identified through the electronic medical record. Variables relevant to the feasibility of IUS were analyzed, including gestational age, body mass index (BMI), IBD subtype and known disease location, and segmental visualization rates were obtained. Univariate analysis was conducted to evaluate associations between visualization limitations and IBD subtype, trimester of gestation, and BMI.

Results: A total of 40 IUS scans were identified. Median gestational age at IUS was 24 weeks (IQR: 19-31) and median BMI at IUS was 27Kg/m² (IQR: 25-30). The most common IBD subtype was Crohn’s disease (CD) (60%), followed by ulcerative colitis (UC) (37.5%), and indeterminate colitis (2.5%). Ileo-colonic and pancolitis were the most common disease locations for CD and UC, respectively. The previously known disease locations were visualized in 95% of IUS. The visualization rate per segment from the descending colon to terminal ileum/neo-terminal ileum was 100%, the remaining segments had a visualization rate of 98% for sigmoid colon, 87% for rectum, and 85% for proximal small bowel. A total of 11 IUS scans had limitations in visualizing ≥1 segment; these limitations were not significantly associated to IBD subtype, BMI, or trimester of gestation. Sub-analysis by segment of limitation revealed a significant association between proximal small bowel limitations and trimester of gestation (p=0.015).

Discussion: IUS proved to be a safe, non-invasive, and reliable tool for segmental visualization and monitoring of IBD during pregnancy in our cohort. There were no major limitations associated with the study across all patient and pregnancy characteristics, differing from the literature. In our cohort, the only segmental limitation significantly associated with trimester of gestation was the proximal small bowel.


Figure: Figure 1. Characteristics of the cohort.
*1 proctectomy.
**5 ileocecectomies.
IUS: intestinal ultrasound, IQR: interquartile range, BMI: body mass index, IBD: inflammatory bowel disease.



Figure: Figure 2. Univariate analysis by A) limitations in any segment in IUS, B) proximal small bowel limitations, C) rectum limitations.
IUS: intestinal ultrasound, IBD: inflammatory bowel disease, BMI: body mass index.


Disclosures:
Oscar Noble indicated no relevant financial relationships.
Ana Paola Islas Guerra indicated no relevant financial relationships.
Hannah O'Neill indicated no relevant financial relationships.
Poojasree Pasupuleti indicated no relevant financial relationships.
Christopher Fan indicated no relevant financial relationships.
Bincy Abraham: Abbvie – Consultant, Speakers Bureau. Celltrion – Consultant. Eli Lilly – Consultant, Speakers Bureau. Johnson and Johnson – Consultant, Speakers Bureau. Pfizer – Consultant. Sanofi – Consultant. Takeda – Consultant, Speakers Bureau.

Oscar Noble, MD¹, Ana Paola Islas Guerra, MD¹, Hannah O'Neill, MD², Poojasree Pasupuleti, MS¹, Christopher Fan, MD³, Bincy Abraham, MD, MS, FACG⁴. P1195 - Feasibility of Intestinal Ultrasound in Pregnant Patients with IBD: A Safe and Reliable Modality for Disease Monitoring, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.