P0268Early biochemical remission with point of care intestinal ultrasound guided treatment decision

Background Intestinal ultrasound (IUS) is emerging as the preferred, non-invasive, accurate, and patient-friendly investigation for Inflammatory Bowel Disease (IBD). This study aims to define its utility in IBD patients with biochemical relapse. Methods This is a retrospective review of IBD patients with biochemical relapse in Singapore General Hospital IBD outpatient clinic where 2 periods were analysed, before (June 2024 – Nov 2024) and after (Nov 2024 – June 2025) the introduction of Point of Care (POC) IUS. Biochemical relapse is defined as C-Reactive Protein (CRP) > 5mg/L and/or Faecal Calprotectin (FCal) > 250ug/g from a previously normal result on a patient with stable medication without corticosteroid 3 months prior. Patients with stoma or pouch were excluded. Management plan was labelled as IUS driven if POC IUS was performed to investigate the biochemical relapse. Baseline demographic, 6-months follow up, and clinical decision based of the relapse were captured. An event (primary endpoint) is achieved when the first biochemical remission is recorded by 6 months follow up after initial relapse. Events are censored if no biochemical relapse is documented after 6 months, or initial decision was changed during subsequent follow up before 6 months. Results A total of 134 patients who fulfilled inclusion criteria were identified. (Table 1) Of this, 29 patients (21.6%) had symptoms (PRO2≥1) while rest were asymptomatic. Biochemical remission was achieved by 79 patients. After the introduction of IUS, there is a reduction of endoscopic / cross sectional imaging (Δ18.4%) and watchful waiting strategy (Δ17.7%) in favour of POC IUS group. Of the 24 patients who had POC IUS, 18 patients (75%) achieved biochemical remission with 14 (58.3%) showing sonographic inflammation leading to treatment escalation (10), and endoscopy (1). There is significant improvement in biochemical remission rate after POC IUS introduction compared to before. (p < 0.018, Figure 1) After IUS introduction, the use of POC IUS is a significant factor (adjusted for gender, age, IBD types, presence of symptoms) leading to achieving biochemical remission. (aOR 5.18 CI 95% 1.27-21.13, p = 0.02) Although median time to achieve remission did not differ between the two different periods; patients who had POC IUS on initial relapse had a median time of 19.0 weeks (IQR 14.0-27.0) to achieve remission. Conclusion POC IUS-guided management improved time to achieve biochemical remission and reduced reliance on invasive procedure and cross-sectional imaging, supporting its role as an effective follow-up tool in IBD. Conflict of interest: Dr. Lim, Chong Teik: No conflict of interest Leong, Justin: No conflict of interest Tan, Yi Yuan: No conflict of interest Tay, Shu Wen: No conflict of interest Salazar, Ennaliza: No conflict of interest Tan, Teck Kiang Malcolm: No conflict of interest