The introduction of an intestinal ultrasound service is associated with significantly reduced endoscopy usage in an inflammatory bowel disease service—the SCOPELESS study

Abstract Introduction Endoscopy has been the gold standard for the assessment of inflammatory bowel disease (IBD) activity. Increasingly, intestinal ultrasound (IUS) is utilized as an alternative non-invasive disease monitoring strategy. The aim of this study was to quantify and compare endoscopy usage for evaluation of IBD disease activity before and after the introduction of an IUS service. Methods A retrospective single-center study was performed. Total numbers of lower gastrointestinal endoscopies performed for assessment of disease activity in luminal Crohn’s disease or ulcerative colitis were collected across two 5-year time periods: the pre-IUS era (2010-14) and the IUS era (2015-19). Endoscopies for dysplasia surveillance were excluded. The primary outcome was a comparison between the pre-IUS and IUS eras of the number of endoscopies performed for IBD activity assessment annually relative to the number of annual patients reviewed. Results The number of endoscopies performed for IBD activity assessment decreased from 576 in the pre-IUS era to 474 in the IUS era despite an increase in cumulative annual patients (1746 vs 3080 patients in the pre-IUS and IUS eras, respectively). The proportion of cumulative annual endoscopies relative to cumulative patients reduced from 33 per 100 patients (pre-IUS era) to 15 per 100 patients (IUS-era) (incidence rate ratio 0.47, 95% CI 0.41-0.53; P .001), a reduction of 53%. Discussion Following the introduction of an IUS service, the number of endoscopies performed for evaluation of IBD activity was halved. The potential workflow and cost savings of this reduction in endoscopy utilization may be significant.