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

Abstract 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