The Rise of Intestinal Ultrasound in Clinical Practice

By Sara Pepitone

Intestinal ultrasound is an emerging diagnostic tool that has recently found its place in the clinic, particularly in the evaluation of chronic gastrointestinal conditions such as inflammatory bowel disease (IBD). This modality, which allows clinicians to visualize the intestine in real time without the need for invasive procedures, has become a standard part of clinical practice in Europe and Canada, especially in settings where noninvasive methods are preferred.

Intestinal ultrasound is still catching on in the United States, but Columbia is at the forefront, introducing the treatment to patients in April 2024. Today, clinicians are increasingly incorporating ultrasound into their clinical workflows.

“Intestinal ultrasound is essentially an advanced form of the traditional stethoscope,” says Joseph Picoraro, MD, associate professor of pediatrics and medical director of the Pediatric IBD Center at Columbia. “The shift toward using it in the clinic represents a growing trend in point-of-care ultrasound.”

For years, diagnostic tools like MRI and CT scans dominated the imaging landscape for abdominal conditions. These methods are highly effective, Dr. Picoraro says, but come with drawbacks, including high costs, radiation exposure, and lengthy exam times.

Intestinal ultrasound is noninvasive, radiation-free, and can be performed at the point of care, making it a compelling alternative. Due to improvements in this technology, it can now provide detailed information about the small and large intestine, revealing signs of inflammation, wall thickening, and other abnormalities typical of conditions like Crohn’s disease and ulcerative colitis.

This advancement is particularly significant for conditions that require frequent monitoring over long periods—patients can undergo regular assessments without the burden of invasive procedures.

 “GI doctors are using ultrasound to monitor the progress of IBD after a diagnosis is made,” Dr. Picoraro says. “For example, after starting a patient on medication, we might do an ultrasound after 10-12 weeks to see how the intestine is responding.”

The ability to perform an ultrasound during a routine visit, immediately assess the findings, and adjust treatment accordingly is a game-changer for both patients and health care providers. And it’s particularly important for conditions like IBD, where subtle changes in disease activity can occur between standard invasive diagnostic tests. Inflammation or other complications may be visible on ultrasound before the patient feels symptoms. In some cases, intestinal ultrasound can replace more invasive methods like endoscopy, offering a faster, less costly, and more comfortable alternative for patients.

In pediatric populations, where more invasive procedures like MRI can be challenging, ultrasound offers a way to monitor conditions without the need for sedation or prolonged imaging sessions. Many patients find it soothing—some in Dr. Picoraro’s practice have even fallen asleep during the procedure.

“The real value of intestinal ultrasound lies in its ability to enhance patient-provider communication,” Dr. Picoraro says: rather than waiting for the results of a distant imaging study, a physician can review ultrasound images with the patient in real time. Immediate feedback helps to demystify the diagnostic process and involves patients in their own care. For conditions like IBD, where treatment plans must be adjusted based on ongoing monitoring, the ability to incorporate ultrasound directly into clinical care helps streamline decision-making.

Though its use is still expanding, the evidence supporting the effectiveness of intestinal ultrasound in clinical settings continues to grow.

Research at Columbia, including studies by David Kessler, MD, professor of pediatrics in emergency medicine, increasingly demonstrates the positive impact of point-of-care ultrasound on treatment decisions and patient outcomes, making it a valuable tool in the management of a variety of diseases.

As more physicians and staff are trained to use this technology and the benefits become clearer, Dr. Picoraro says, “intestinal ultrasound is poised to become a standard part of clinical practice in gastroenterology, transforming how we monitor and treat gastrointestinal conditions.”