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Ultraschall Med. 2019 Apr;40(2):163-175. doi: 10.1055/a-0824-6952. Epub 2019 Jan 7.

EFSUMB Position Paper: Recommendations for Gastrointestinal Ultrasound (GIUS) in Acute Appendicitis and Diverticulitis.

Author information

Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Germany.
Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Roma, Italy.
Medizinische Klinik 2, Caritas-Krankenhaus, Bad Mergentheim, Germany.
Haukeland-University-Hospital, National Centre for Ultrasound in Gastroenterology, Bergen, Norway.
Department of Medicine, Haukeland-University-Hospital, Bergen, Norway.
Department of Radiology, Queen-Alexandra-Hospital, Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom of Great Britain and Northern Ireland.
Radiologie und Nuklearmedizin, KH Barmherzige Brüder, Salzburg, Austria.
Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L. Sacco" University-Hospital, "L. Sacco" University-Hospital, Milan, Italy.
Ambulanzzentrum Gastroenterologie, Klinikum Lüneburg, Germany.
Gastroenteroloy, Medical School Brandenburg Theodor Fontane, Neuruppin, Germany.
Gastroenterology, Haukeland-University-Hospital, Bergen, Norway.
Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Roma, Italy.
Radiology, Hospital Universitario Doctor Peset, Valencia, Spain.
Dept. of Radiology, Radiologia 1, Spedali Civili di Brescia, Italy.
Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Romania.
Department of Digestive System, Sant'Orsola-Malpighi-Hospital and University of Bologna, Italy.
Zentrale interdisziplinäre Sonografie, Brüderkrankenhaus, Trier, Germany.
Gastroenterology, University of Medicine and Pharmacy Timisoara, Romania.


in English, German

An interdisciplinary task force of European experts summarizes the value of gastrointestinal ultrasound (GIUS) in the management of acute appendicitis and diverticulitis. Based on an extensive literature review, clinical recommendations for these highly common diseases in visceral medicine are presented.In patients with acute appendicitis, preoperative sonography has been established as a routine procedure in most European countries for medical and legal reasons. Routine sonography in these patients may reduce the rate of unnecessary surgery by half. The sensitivity, specificity, and accuracy of ultrasound reach values above 90 % and are equivalent to CT and MRI. However, the high operator dependence may be a problem, for example in point-of-care ultrasound in emergency departments. Structured training programs, quality controls and standardized ultrasound reporting should be increasingly implemented.In the case of suspected acute diverticulitis, "ultrasound first" should also be a basic element in the approach to all patients. Sonography can confirm the diagnosis and allows early risk stratification. As treatment strategies have become less aggressive and more tailored to the stage of diverticulitis, accurate staging has become increasingly important. GIUS and CT have proven to have similar sensitivity and specificity. Especially in cases of uncomplicated diverticulitis, GIUS will be the one and only imaging procedure. CT may work as a backup and has particular advantages for diverticulitis located in the distal sigmoid, inflammation deep in the small pelvis and insufficient ultrasound scanning conditions. This step-up approach (ultrasound first and CT only in case of a negative or inconclusive ultrasound result) has proven to yield the best accuracy.


Conflict of interest statement

Speaker honoraria, Pentax Medical Singapore LtdConsulting/Advisory board, Mediglobe Corporation GmbhCongress participation support, Hitachi Medical Systems UKSpeaker honoraria, Abbvie, Janssen, TakedaSpeaker honoraria, Bracco, Hitachi, GE, Mindray, Supersonic, Pentax, Olympus, Fuji,Boston Scientific, AbbVie, Falk Foundation, Novartis, Roche; AdvisoryBoard Member, Hitachi, Mindray, Siemens; Research grant, GEMindray, SuperSonicSpeaker honoraria, AbbVie, Bracco, Almirall, GE Healthcare, Takeda AS, Meda AS, Ferring AS, AllegaConsultant fee Bracco, GE Healthcare, Takeda and SamsungSpeaker honoraria, Abbvie, Falk Foundation, Ferring, Janssen-Cilag, MSD, Pfizer, Takeda;Advisory Board/Consultant fee: Abbvie, Celgene, Janssen-Cilag, MSD, TakedaSpeaker honoraria, Abbvie, Alfa Sigma, Janssen-Cilag; Advisory Board/Consultant fee, Allergan, Novartis, Takeda, THDSpeaker honoraria, Falk Foundation; Research grant, GE HealthcareSpeaker honoraria, Meda AS, Ferring pharmaceuticals, TakedaSpeaker honoraria, Philips, GE, Canon; Advisory Board Member, Siemens; Congress participation support, SiemensSpeaker honoraria Bracco, Toshiba. Advisory board member Bracco. Education support Philips. Technical consultancy Philips, BK The following members declared no conflicts of interest: Klaus Dirks, Trygve Hausken, Antony Higginson, Alois Holleweger, Nadia Palotta, Tomás Ripollés, Laura Romanini, Carla Serra

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