MUSC's new intestinal ultrasound allows pediatric and adult patients to extend time between colonoscopies

Physicians can now acquire live images of the colon without patient prep or anesthesia

By Celia Spell

MUSC Health is now part of a small cohort of academic medical centers in the United States offering intestinal ultrasound to patients with inflammatory bowel disease (IBD).

Most options for imaging the small bowel and colon are expensive, like an MRI, or require intensive preparation, like a colonoscopy. And even with these imaging options, real-time imaging is not a choice, which means patients often need a follow-up appointment with their physicians to discuss the results at a later point in time.

Erin Forster, M.D., director of the MUSC Health IBD Medical Home, commonly sees patients with Crohn's disease or ulcerative colitis, and she says there are many benefits to the intestinal ultrasound. "It can be a way to see how well a medication is working or it can indicate when a change of therapy is needed," she said. "It can also identify complications of IBD, like strictures, fistulae and abscesses, or offer an alternative to someone who can't undergo a colonoscopy at the moment."

Physicians started using ultrasound as a medical imaging tool in the 1950s. By using inaudible sound waves and the echoes as they deflect off an object, physicians can see organs, blood vessels and infants in the womb. According to a paper in the journal RadioGraphics, two Harvard students hypothesized in 1938 that bats travel safely at night by clicking and hearing the sound waves bounce back to them, a process we know as echolocation. And now we can bring that imaging technology to MUSC to assess the bowel.

Even though intestinal ultrasound has been commonly used in Europe, Canada, Australia and Israel for decades, its use in the United States is new and still not widely available. Forster thinks the hospital's use will make waves in the Southeast since there are so few other centers with physicians trained to perform it.

However, she also points out that it is not an alternative to current colon cancer screening protocols but an addition. "Intestinal ultrasound is not intended to replace colonoscopy or colon cancer screening," she said, "but it can help optimize therapy by adjusting the timing of the colonoscopy to make it more valuable and meaningful for the patient."

MUSC Children's Health also currently offers intestinal ultrasound as part of a pilot initiative to pediatric patients. Forster is completing her training this month and will be able to offer intestinal ultrasound to adult patients by the end of the summer. By offering this screening option to both pediatric and adult patients, MUSC will continue its focus on the whole patient. Children with IBD can continue that same care from childhood and into adulthood, which isn't often the case.

Garth Swanson, M.D., AGAF, is a professor of medicine and the division director of gastroenterology and hepatology at MUSC. He works with Forster and says intestinal ultrasound is just one way MUSC is a leader in inflammatory bowel disease medical advancements, especially in the Southeast.

"Intestinal Ultrasound is just one example of this advancement," he said. "It's a cutting-edge technology that is beneficial for patients and their families to stay ahead of what can be a debilitating condition. This is an exciting time and the next stage in building a state-of-the-art IBD Home at MUSC."

Forster says one of the tenets of IBD care is shared decision making, which the National Learning Consortium (PDF) describes as a process where clinicians and patients work together to make decisions and select which tests and evidence-based treatments are right for them. While the medical community in general uses this model, Forster says it's particularly integral to IBD care.

"Intestinal ultrasound allows us to have an even more complete picture of a patient's current status –incorporating findings with their symptoms as well as lab tests and endoscopic information," Forster said.

And with intestinal ultrasound, patients can see the results of their tests in real time since they're not under anesthesia. They can see what the physician sees and ask questions. "And then we can figure it out together as a team," she said.

Forster echoes the continuity of care for IBD patients transitioning from the pediatrics world: "I think it's really special," she said, "that pediatric patients and adult patients can be seen throughout the course of their IBD story. A lifetime of IBD care can be done right here using this technology."

Forster and her team are conducting studies to quantify intestinal ultrasound as a successful imaging tool compared to traditional methods. With her training concluding in May, she is looking forward to using intestinal ultrasound as an option for patients across the state.

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