Letter: Intestinal Ultrasound‐Prioritising Progress

We read with great interest the article by Lu et al., entitled ‘Extending the Frontiers of Intestinal Ultrasound Knowledge, Performance, and Expansion’ 1. The authors provide a comprehensive umbrella review of current evidence supporting intestinal ultrasound (IUS) in inflammatory bowel disease (IBD) and highlight knowledge gaps across domains including: assessment of luminal disease activity, postoperative recurrence, IBD complications, rectal/pouch ultrasound, IUS in paediatrics, contrast-enhanced intestinal ultrasound (CEUS), elastography, emerging artificial intelligence (AI) applications, and global training and implementation. Through their critical analysis of 61 systematic reviews and consensus statements, the authors demonstrate that current evidence has remained imprecise and incomplete due to a limited number of studies and small sample sizes. Although IUS is non-invasive and well-tolerated, its integration in clinical and research settings remains limited, likely due to the multifactorial challenges described across the reviewed domains. The authors rightly identify the lack of a rigorously validated, clinically meaningful predictive scoring system (i.e., treatment response) as a major barrier to meaningful clinical integration. In our view, progress in IUS adoption hinges on prioritising validation of a single scoring system rather than perpetually comparing multiple indices. The IBUS-SAS score, which has the most research support, could serve as this foundation. Recent studies demonstrate its strong correlation with clinical, biomarker and endoscopic measures in Crohn's disease, alongside promising validation in ulcerative colitis 2-5. A structured, multicenter effort that incorporates reproducibility, responsiveness and outcome correlation would provide the necessary benchmark. We eagerly await the UltraSound Examination of the Intestine to Detection Inflammation, response and Healing in Crohn's Disease Treatment trial (USE-IT) which aims to do just this. The authors correctly identify the difficulty of establishing standardised training and certification. Given the heterogeneous background of ultrasonographers performing IUS (internists, gastroenterologists, radiologists, ultrasound technicians, etc.), competency benchmarks and consensus-driven curricula are essential. Integrating IUS training into fellowship programmes and continuing education could accelerate adoption. We commend the efforts of International Bowel Ultrasound Group (IBUS) and Intestinal Ultrasound Group of the United States and Canada (IUSCAN) in advancing education. Initiatives such as IUSCAN's recent plan to offer free ultrasound training for gastroenterology fellows represent meaningful progress. Still, formalised curricula and certification standards remain essential for widespread adoption. Finally, the authors' call for exploring AI integration is timely. While AI-assisted interpretation could mitigate variability and enhance diagnostic accuracy, robust validation studies are needed first. Further, scoring validation would be pertinent for enhancing AI-assisted programming, likely preferred prior to the implementation of AI. Therefore, we believe scoring validation should serve as the foundation for developing reliable AI-assisted tools. Ultimately, research is needed across all domains of IUS, many of which can progress in parallel. While the publication mentions that IBUS will strategise research priorities, we believe the most immediate needs are developing adaptive, predictive IUS indices and strengthening educational frameworks. In summary, Lu et al. provide a valuable roadmap for advancing IUS in IBD care. Continued collaborative research, standardisation and education is pivotal in realising the full potential of this modality. Kacie H. Denton: writing – original draft, investigation. Dhyanesh A. Patel: conceptualization, writing – review and editing. Baldeep S. Pabla: investigation, writing – original draft, writing – review and editing. The authors have nothing to report. K.H.D. (The author declares no conflicts of interest); D.A.P. (Consulting for Phathom Pharmaceuticals, Sanofi; Advisory board for Sanofi; Speaker fees from Sanofi and Regeneron); B.S.P. (Advisory board fees from J consultant fees from AbbVie; Speaker fees from Prometheus, Eli Lilly). This article is linked to Lu et al. paper. To view this article, visit https://doi.org/10.1111/apt.70449. The data that supports the findings of this study are available in the Supporting Information of this article.