Table 3.
RAND/UCLA process results.
| 3.3. Statements for both Crohn’s disease and ulcerative colitis | |||||
|---|---|---|---|---|---|
| 3.3.1. | Machine recommendations | InA | Unc | App | Total |
| 3.3.1.1. | Treatment response can be assessed by intestinal ultrasound | 0 | 0 | 17 | 17 |
| 3.3.1.2 | Response should be assessed with: | ||||
| 3.3.1.2.1. | - the same type of probe [high-frequency vs. abdominal probe] | 0 | 2 | 15 | 17 |
| 3.3.1.2.2. | - constant machine settings [Doppler scale, preset, etc.] | 1 | 1 | 15 | 17 |
| 3.3.2. | Response rate | ||||
| 3.3.2.1 | Response rate detected by intestinal ultrasound is comparable with: | ||||
| 3.3.2.1.1. | - rate of improvement in luminal inflammation, assessed by endoscopy | 0 | 3 | 14 | 17 |
| 3.3.2.1.2. | - rate of magnetic resonance enterography improvement | 0 | 0 | 17 | 17 |
| 3.3.2.2. | Response rate in intestinal ultrasound is depending on: | ||||
| 3.3.2.2.1. | - class of drug [mesalazine vs. steroids vs. immunosuppressants vs. biologics] | 1 | 3 | 13 | 17 |
| 3.3.2.2.2. | - disease duration [new onset vs. long-term established disease] | 0 | 2 | 15 | 17 |
| 3.3.2.2.3. | - histological composition of pathological segment [active inflammation only vs. fibrotic only vs. combined] | 0 | 1 | 16 | 17 |
| 3.3.2.3. | Response time is generally shorter in ulcerative colitis compared with Crohn’s disease | 0 | 1 | 16 | 17 |
| 3.3.2.4. | In responders, colonic disease tends to respond faster with respect to bowel wall thickness than small bowel disease | 0 | 2 | 15 | 17 |
| 3.3.2.5. | Response rate in general is different for: | ||||
| 3.3.2.5.1. | - strictures than luminal disease | 0 | 2 | 15 | 17 |
| 3.3.2.5.2. | - phlegmons than luminal disease | 0 | 3 | 14 | 17 |
| 3.3.2.5.3. | - abscesses than luminal disease | 0 | 2 | 15 | 17 |
| 3.3.3. | Length of disease | ||||
| 3.3.3.1. | Length in both Crohn’s disease and ulcerative colitis should be reported using involved colonic segment[s] [sigmoid colon, descending colon, transverse colon, ascending colon, caecum] | 0 | 0 | 18 | 18 |
| 3.3.3.2. | For terminal ileum, length should be reported as distance in cm and distance from ileocaecal valve [if possible] or as proximal small bowel | 0 | 0 | 18 | 18 |
| 3.3.4. | Measuring bowel wall thickness | ||||
| 3.3.4.1. | Response depends on baseline thickness and should be reported in: | ||||
| 3.3.4.2. | - absolute [mm] and relative [%] change from baseline | 2 | 1 | 14 | 17 |
| 3.3.4.3. | - continuous measurements and is preferred over categories | 0 | 1 | 15 | 16 |
| 3.3.4.4. | - continuous measurements and should be measured with one decimal for increased precision | 0 | 1 | 16 | 17 |
| 3.3.4.5. | - continuous measurements, as a mean of two measures in cross-section and two measures in longitudinal orientation | 1 | 1 | 15 | 17 |
| 3.3.5. | Defining the worst segment | ||||
| 3.3.5.1. | The worst segment in both Crohn’s disease and ulcerative colitis is defined by the most pathological bowel wall thickness; however, if two segments have the same bowel wall thickness, the order of secondary parameters for defining the worst segment should be the grading of colour Doppler signals, bowel wall stratification, and then inflammatory mesenteric fat, respectively | 0 | 1 | 17 | 18 |
| 3.3.6. | Disease activity indices | ||||
| 3.3.6.1. | If a score is used, the score should summarise measures of all individual segments | 0 | 3 | 14 | 17 |
| 3.3.6.2. | Treatment response could be a combined change in one or more activity parameters, specified as a point-reduction from an activity score [present or in the future], bowel wall thickness [continuous], and/or colour Doppler signals [ordinal], and/or bowel wall stratification [ordinal], and/or inflammatory mesenteric fat [ordinal] [IBUS-SAS] | 0 | 3 | 14 | 17 |
| 3.4. Crohn’s disease | |||||
| 3.4.1. | Response definition and timing of assessment in Crohn’s disease | ||||
| 3.4.1.1. | Treatment response is identified by reduction of bowel wall thickness [continues measurements] [>25% or >2.0 mm or [>1.0 mm and one colour Doppler signal reduction] | 0 | 3 | 15 | 18 |
| 3.4.1.2. | Intestinal ultrasound complications that should be assessed for response: | ||||
| 3.4.1.2.1. | - strictures | 0 | 2 | 15 | 17 |
| 3.4.1.2.2. | - phlegmons | 0 | 3 | 14 | 17 |
| 3.4.1.2.3. | - abscesses | 1 | 3 | 13 | 17 |
| 3.4.1.3. | Response should initially be assessed in the small and large bowel after treatment initiation [regardless of treatment] at 14 ± 2 weeks. However, in a subset of patients, response after steroids or biologics may occur already after 4 weeks. Early intestinal ultrasound assessment may in certain situations be beneficial between Weeks 4 and 8 | 0 | 0 | 17 | 17 |
| 3.4.1.4. | Ideal assessment of intestinal ultrasound response within first year of treatment initiation/escalation/change is at baseline, Week 14 ± 2, and between Weeks 26 and 52 + IUS depending on elevated faecal calprotectin or symptoms or clinical suspicion of flare | 1 | 1 | 15 | 17 |
| 3.4.2. | Transmural remission, definition and timing of assessment in Crohn’s disease | ||||
| 3.4.2.1. | Transmural remission of terminal ileum, small and large bowel is defined by bowel wall thickness ≤3 mm and normal/0 colour Doppler signal | 0 | 1 | 17 | 18 |
| 3.4.2.2. | In some patients, sigmoid colon may contain an enlarged muscularis propria [outer hypoechoic layer—typical in diverticular disease], allowing for bowel wall thickness up to 4 mm without resembling active inflammation | 3 | 1 | 13 | 17 |
| 3.4.2.3. | Transmural remission should be assessed after treatment initiation [regardless of treatment] between 26 and 52 weeks. | 0 | 3 | 14 | 17 |
| 3.4.2.4. | Transmural remission may occur already at Week 12 but with increasing likelihood up to 1 [maybe 2] years | 0 | 0 | 17 | 17 |
| 3.5 Ulcerative colitis | |||||
| 3.5.1. | Response definition and timing of assessment in ulcerative colitis | ||||
| 3.5.1.1. | Treatment response in ulcerative colitis is identified by reduction of bowel wall thickness [continuous measurements] [>25% or >2.0 mm or >1.0 mm and one colour Doppler signal reduction] | 0 | 3 | 15 | 18 |
| 3.5.1.2. | Ideal assessment of intestinal ultrasound response within first year of treatment initiation/escalation/change is at baseline, Week 14 ± 2, and between Weeks 26 and 52 + intestinal ultrasound depending on elevated faecalcalprotectin or symptoms or clinical suspicion of flare | 0 | 2 | 14 | 16 |
| 3.5.1.3. | After treatment initiation, response should be measured in all segments that were affected at baseline | 0 | 0 | 14 | 14 |
| 3.5.2. | Transmural remission, definition, and timing of assessment in ulcerative colitis | ||||
| 3.5.2.1. | Transmural remission in ulcerative colitis of the large bowel is defined by bowel wall thickness ≤3 mm and normal/0 colour Doppler signal | 0 | 1 | 17 | 18 |
| 3.5.2.2. | In some patients, sigmoid colon may contain an enlarged muscularis propria [outer hypoechoic layer—typical in diverticular disease], allowing for bowel wall thickness up to 4 mm without resembling active inflammation | 3 | 1 | 13 | 17 |
| 3.5.2.3. | Transmural remission in ulcerative colitis should be assessed after treatment initiation [regardless of treatment] at Week 14 ± 2. | 0 | 2 | 16 | 18 |
| 3.5.2.4. | Transmural remission in ulcerative colitis may occur already at Week 4 but with increasing likelihood up to Week 12 [potentially 1 year] | 1 | 3 | 14 | 18 |
| 3.6. Adults vs. paediatric population | |||||
| 3.6.1. | The remission/response statements for Crohn’s disease, may be used in both adult and paediatric populations | 2 | 1 | 14 | 17 |
| 3.6.2. | The remission/response statements for ulcerative colitis, may be used in both adult and paediatric populations | 2 | 2 | 12 | 16 |
| Under inappropriate [InA], uncertain [Unc], and appropriate [App], the number of panellists voting as either 1–3, 4–6, or 7–9 is presented. |
IBUS-SAS, International Bowel Ultrasound Segmental Activity Score; IUS, intestinal ultrasound.