Clinical appraisal of handheld intestinal ultrasound in inflammatory bowel disease: Where are we now?: GI Signals

IBD review · Aug 7, 2026 · Inflamm Bowel Dis · IF 4.5

Clinical appraisal of handheld intestinal ultrasound in inflammatory bowel disease: Where are we now?

New evidenceulcerative colitisCrohn's diseaseartificial intelligence

Clinical takeawayIf your practice uses handheld intestinal ultrasound, implement it with structured training (supervised practice, image quality review, feedback) for bedside IBD triage and bowel wall thickness assessment, with predefined escalation to conventional ultrasound, MR enterography, or endoscopy for complex disease, deep pelvic lesions, or suspected complications. Do not rely on handheld color Doppler in Crohn's disease.

What it foundHandheld intestinal ultrasound demonstrates diagnostic performance comparable to conventional ultrasound for IBD bowel wall assessment, with color Doppler feasible in ulcerative colitis but insufficiently validated in Crohn's disease; limitations persist for deep pelvic lesions and complications.

ContextHandheld ultrasound emerges as a portable adjunct to conventional ultrasound in IBD. Current practice relies on conventional ultrasound and cross-sectional imaging for comprehensive IBD assessment; HHIUS may reduce workflow barriers to bedside-point triage in resource-limited settings but does not yet replace standard imaging for complex disease. The paper clarifies what this technology can and cannot do safely, based on early published studies.

Emergingsuggested applicable standard· ACG Clinical Guideline Update: Ulcerative Colitis in Adults, Am J Gastroenterol 2025;120(6):1187-1224; AGA Living Guideline on Pharmacological Management of Moderate-to-Severe UC, Gastroenterology 2024 (panel review March 2026, no changes)

Decision at stakeMonitor disease activity in treated ulcerative colitis using endoscopy to achieve mucosal healing target (MES 0-1)

Confirm ulcerative colitis with endoscopy showing continuous colonic inflammation from the rectum plus histology, after excluding infection with two-step CDI testing. … Apply treat-to-target (STRIDE-II) to endoscopic improvement (MES 0-1). …

From our summary of this standard, unedited — the part the paper bears on. … marks omitted text. Our wording, not the guideline's; read the source for its own text.

Our full summary of this standard

Confirm ulcerative colitis with endoscopy showing continuous colonic inflammation from the rectum plus histology, after excluding infection with two-step CDI testing. Treat mild-moderate disease with 5-ASA by route and extent (suppository for proctitis, enema for left-sided, oral plus rectal for extensive); if 5-ASA fails, treat as moderate-to-severe rather than stepping up gradually. Position advanced therapy by EFFICACY TIER, not by an anti-TNF-first rule. Advanced-therapy-naive, higher efficacy: infliximab, vedolizumab, ozanimod, etrasimod, upadacitinib, risankizumab, guselkumab; intermediate: golimumab, ustekinumab, tofacitinib, filgotinib, mirikizumab; lower: adalimumab. PREVIOUSLY TNF-EXPOSED, higher efficacy: tofacitinib, upadacitinib, ustekinumab; lower: adalimumab, vedolizumab, ozanimod, etrasimod - S1P modulators are weakest in exactly this group. Do not cycle within the anti-TNF class after primary non-response; switch mechanism. Apply treat-to-target (STRIDE-II) to endoscopic improvement (MES 0-1). Screen for acute severe UC by Truelove-Witts and admit for IV steroids. Begin CRC surveillance 8-10 years after DIAGNOSIS for extensive or left-sided disease; isolated proctitis follows average-risk screening.

ACG Clinical Guideline Update: Ulcerative Colitis in Adults, Am J Gastroenterol 2025;120(6):1187-1224; AGA Living Guideline on Pharmacological Management of Moderate-to-Severe UC, Gastroenterology 2024 (panel review March 2026, no changes) ↗

Miyatani Y … On Behalf Of The Intestinal Ultrasound Group Of The United States And Canada iUSCAN Research Committee · Inflammatory Bowel Diseases · IF 4.5 · PubMed ↗Permalink