Abstract

Objectives To evaluate current UK practice for inflammatory bowel disease (IBD) imaging against recommendations from published international literature. Methods A retrospective multi-centre audit was undertaken evaluating imaging modalities, protocols, and pathways used to investigate IBD both in outpatient and inpatient settings during January-December 2022. Reporting practices and training provisions were also recorded. Results Forty-one centres contributed: 35 centres provided complete data, whereas 6 centres provided incomplete data. Magnetic resonance enterography (MRE) was the most common modality for small bowel imaging across UK centres, comprising 13 099/18 784 (69.7%) investigations. There was regional variability in other modalities used, with 5 centres performing 81% of all intestinal ultrasound and 3 centres performing 65% of all small bowel follow-through. Compared with outpatients, inpatients with suspected IBD were significantly more likely to be imaged with techniques imparting ionising radiation whether scanned either in-hours (p = 0.005) or out-of-hours (p < 0.001). Non-ionising radiation imaging modalities were significantly less available out-of-hours (p < 0.0001). Sequences included in MRE protocols were variable. Disparity in imaging follow-up for patients prescribed biologic therapies was observed. Conclusions Considerable variation in UK IBD imaging practice has been identified. Improvements must be made to reduce the regional inequality of patient access to different imaging modalities and decrease reliance on ionising radiation for inpatients. Further research to standardise and optimise imaging pathways should be undertaken to improve uniformity, with emphasis placed on training and education. Advances in knowledge This multi-centre audit showed considerable IBD imaging practice variation between UK centres, particularly for imaging modalities used between inpatient and outpatient groups and in-hours versus out-of-hours.