Intestinal ultrasound-guided management has substantial cost savings and reduction in carbon footprint in an inflammatory bowel disease service.

BACKGROUND

Intestinal ultrasound (IUS) is an accurate, noninvasive, radiation-free, point-of-care investigation for inflammatory bowel disease (IBD) with potential to reduce economic and environmental burden within a healthcare system. We aimed to evaluate the cost savings and carbon footprint impact of a newly established IUS service in a tertiary IBD unit.

METHODS

A prospective registry of all IUS examinations performed between January 2024 and October 2025 at a single Australian tertiary center was analyzed. Patients were referred for IUS first prior to consideration of magnetic resonance enterography (MRE) or colonoscopy. Data collected included patient demographics, prior surgery, impact on management, and avoidance of MRE or colonoscopy. The primary outcome was cost savings and carbon emission reductions attributable to the avoidance of MRE or colonoscopy.

RESULTS

Of 438 IUS examinations analyzed, 371 (85%) were for Crohn's disease, 57 (13%) ulcerative colitis, and 10 (2%) IBD-unclassified. Median age was 44 years (interquartile range = 30-57) and 234 (53.4%) were female; 191 (43.6%) had prior intestinal surgery. IUS-based management avoided 199 MRE and 139 colonoscopies, generating cost savings of $119,201 and $286,479 respectively. Total IUS expenditure was $92 856, yielding net savings of $312 824. Carbon emissions avoided totaled 11 047 kg CO2 (MRE: 3482 kg; colonoscopy: 7784 kg - offset by 219 kg from IUS). Avoided MRE generated energy savings of 488 943 Wh against 7446 Wh consumed by IUS, yielding a net saving of 481 497 Wh.

CONCLUSION

Integration of IUS into routine IBD clinical care limits invasive, high-cost investigations, producing significant reductions in carbon emissions and energy use.