Photo Credit: Jae Young Ju
The researchers of this study evaluated the efficacy of the Bowel Ultrasound Score (BUSS) in predicting long-term endoscopic remission in CD patients.
Continuous monitoring of intestinal lesions is critical in managing Crohn’s disease (CD), explained authors of a study published online in EClinicalMedicine. Traditionally, ileocolonoscopy (IC) has been the standard method for assessing disease activity and treatment efficacy. However, the invasive nature of IC limits its frequent use. Intestinal ultrasound (IUS) offers a non-invasive, real-time alternative to evaluate the small and large bowel, including the deeper layers of the bowel wall.
“IC is currently the gold standard to assess disease activity and the response to treatments,” the authors wrote. “However, it has a limited role in tight monitoring strategies because it cannot be performed repeatedly. Conversely, IUS allows frequent assessments and has the advantage of assessing both the large and the small bowel and examining bowel wall layers beyond the mucosa.”
To better understand different management techniques of CD, the researchers evaluated the efficacy of the Bowel Ultrasound Score (BUSS) in predicting long-term endoscopic remission in CD patients.
The single-center prospective observational study enrolled 93 adult patients with active CD (simple endoscopic score >2) starting biologic therapy between March 2018 and January 2021. The primary objective was to assess whether ultrasound remission at week 12 (BUSS ≤3.52) could predict long-term endoscopic remission at 12 months. Patients underwent both colonoscopy and IUS at baseline and after 12 months. The study also calculated the International Bowel Ultrasound Segmental Activity Score (IBUS-SAS) and used ROC analysis to determine optimal cut-points for detecting endoscopic remission.
The findings revealed that 22 patients (24%) achieved endoscopic remission. Week 12 ultrasound remission significantly predicted long-term endoscopic remission (59% vs 41%; OR, 9.93; 95% CI, 3.10–31.80; P<0.001), whereas week 12 calprotectin values did not show similar predictive power. Notably, the study found that the negative predictive value of week 12 ultrasound activity for long-term endoscopic remission was 87%, while the positive predictive value was 54%. Researchers identified the optimal cut-off for IBUS-SAS to discriminate endoscopic remission as 22.8 (AUC, 0.906), with no significant difference between BUSS and IBUS-SAS in detecting endoscopic remission (P=0.46).
According to the researchers, these results underscore the potential of early ultrasound remission as a valuable treatment target, offering a non-invasive, patient-friendly alternative to IC for frequent monitoring. The study suggests that achieving a BUSS of 3.52 or less by week 12 can effectively predict long-term endoscopic remission, making it a practical target in clinical settings and trials. The BUSS, validated in external cohorts, accurately detects treatment responses and predicts disease progression, which enhances its reliability as a monitoring tool.
Furthermore, the study highlights the need for larger multicenter validation studies to confirm these findings and refine the BUSS cut-off values tailored to different clinical scenarios, including surgery and severe endoscopic activity. Additionally, the combined use of IUS with fecal calprotectin may offer a more robust approach to monitoring, given the limitations of each method when used alone.
In conclusion, this study provides compelling evidence for incorporating IUS, specifically BUSS, as an early treatment target in CD management. By enabling timely and accurate assessments of treatment response, BUSS has the potential to improve patient outcomes through proactive and individualized treatment adjustments. The ongoing refinement and validation of BUSS could establish it as a standard tool in both clinical practice and research, promoting a more effective and patient-centric approach to CD management.
“These discoveries offer the potential for a non-invasive, proactive approach involving early and meticulous monitoring of patients,” they concluded. “This strategy could encompass timely evaluations of treatment response, with the overarching goal of attaining the desired treatment outcome. Extensive multicenter validation studies are essential to substantiate these findings.”
