Mistakes in gastrointestinal ultrasound and how to avoid them

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Mistakes in gastrointestinal ultrasound and how to avoid them

Odd Helge Gilja, Andreas Jessen Gjengstø, Kim Nylund, Hilde L. Von Volkmann

Summary

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A clinical review identifies the ten most common mistakes made in gastrointestinal ultrasound and strategies to avoid them, based on clinical experience and evidence.

Gastrointestinal ultrasound has become increasingly important for diagnosing and following gastrointestinal disorders
As a real-time imaging modality, ultrasound offers advantages over static imaging methods such as CT and MRI and allows various techniques to enhance visualisation
Acquiring good images for correct interpretation can be challenging even for experienced examiners, and several pitfalls exist
The material presents common mistakes in gastrointestinal ultrasound practice and avoidance strategies based on clinical experience with an evidence-based approach
Gastroenterologists and clinicians performing gastrointestinal ultrasound would benefit from reviewing these common pitfalls

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Abstract

Ultrasound is a routine diagnostic procedure widely used in gastroenterology departments worldwide, and gastrointestinal ultrasound (GIUS) has become increasingly important in diagnosing and following gastrointestinal disorders. Being a real-time imaging modality, it has some advantages over static imaging modalities such as CT and MRI, and it allows the examiner to perform various techniques and methods to enhance visualisation. GIUS requires more than essential ultrasound experience, and acquiring good images for correct interpretation can be challenging even for the experienced examiner. As such, there are several pitfalls that clinicians should be aware of. Based on our clinical experience with an evidence-based approach, we present the ten most common mistakes made in gastrointestinal ultrasound and how to avoid them.

Topics

Radiology & Imaging

Citation

Gjengstø AJ, Nylund K, von Volkmann HL and Gilja OH. Mistakes in gastrointestinal ultrasound and how to avoid them. UEG Education 2023; 23: 27-32.

Published

2023

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UEG Mistakes In Articles

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Mistakes in the management of hepatocellular carcinoma and how to avoid them

Spyridon Pantzios, Ioannis Elefsiniotis, Christos Triantos

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Abstract

Liver cancer is the sixth most common cancer and the third leading cause of cancer-related death. Hepatocellular carcinoma (HCC) accounts for about 90% of cases and mostly arises in chronic liver disease, especially cirrhosis. Viral hepatitis remains a leading cause, but alcohol-related disease and MASLD are rising. With immune checkpoint inhibitors transforming HCC management, it is timely to highlight common mistakes across screening, staging, diagnosis and treatment.

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Digestive Oncology Hepatobiliary

Published

2026

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UEG Podcast Episode

UEG Podcast

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Management of gastric preneoplastic lesions (MAPS 3) - what’s new? With Mario Dinis-Ribeiro (Part 2)

Mario Dinis-Ribeiro, Pradeep Mundre

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Abstract

Topics

Stomach & H. Pylori

Published

2025

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Mistakes in endoscopic treatment of Barrett oesophagus neoplasia and how to avoid them

Jacques J. Bergman, Roos E. Pouw, Eva Verheij

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Abstract

Barrett’s oesophagus is a premalignant condition of the distal oesophagus predisposing to oesophageal adenocarcinoma. Given the potential for malignant progression and the poor prognosis of eosophageal adenocarcinoma when diagnosed at a symptomatic stage, patients with known Barrett oesophagus undergo regular endoscopic surveillance to detect neoplastic progression at an early and preferably endoscopically, treatable stage. Endoscopic management of early Barrett oesophagus neoplasia consists of a combination of endoscopic imaging, endoscopic resection and endoscopic ablation. Below we discuss a number of mistakes that are frequently made when managing Barrett oesophagus neoplasia and how to avoid them. Much of this discussion draws on existing guidelines (for background reading, check the ESGE Barrett oesophagus guideline), but in many instances the underlying evidence (even in the guideline) is missing and therefore many of our practically driven recommendations are based on common sense and our experience in this field.

Topics

Oesophagus

Citation

Verheij EPD, Pouw RE and Bergman JJ. Mistakes in endoscopic treatment of Barrett oesophagus neoplasia and how to avoid them. UEG Education 2021; 21: 35–39.

Published

2021

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UEG Standards and Guidelines

Clinical Practice Guideline

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ECCO Guidelines on Therapeutics in Ulcerative Colitis: Medical Treatment

Javier P. Gisbert

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Guideline

Introduction

Ulcerative colitis [UC] is a chronic inflammatory bowel disease [IBD] characterised by colonic inflammation extending to a variable extent from the rectum. Care of the patient with UC requires appropriate input from across the multiprofessional team. These guidelines summarise the recommended medical treatment for adults with UC.

In 2022, the European Crohn’s and Colitis Organisation [ECCO] published new guidelines on the management of UC in two papers focused on the medical and surgical management of the disease.¹^,² For the 2022 UC guidelines, ECCO adopted the Grading of Recommendations Assessment, Development, and Evaluation [GRADE] approach, a systematic process for developing guidelines that addresses how to frame healthcare questions, summarise the evidence, formulate recommendations, and grade their strength and the quality of associated evidence.³ The present paper represents an update to the 2022 guidelines and focuses specifically on the medical management of UC, while a companion paper developed as part of the same process addresses optimal surgical management [ECCO Guidelines on Therapeutics in Ulcerative Colitis: Surgical Treatment].

For this iteration of the guidelines, we have introduced several new, clinically relevant questions selected by members of the guidelines group, alongside a systematic approach to reviewing and updating previous topics to incorporate new evidence and to reappraise all findings within the context of contemporary practice. We have also introduced several “practice points” to summarise evidence and provide expert recommendations in key areas where the evidence remains limited but clinical decisions are still required. In such instances, where application of the GRADE methodology may be impractical, we adopted an approach based on systematic literature review, expert discussion, and voting to reach consensus recommendations outside the formal GRADE process.

Patients living with UC can have a variable disease course.⁴ In this document, we discuss therapeutic approaches stratified by disease severity [mildly-to-moderately active and moderately-to-severely active disease]. Definitions of disease severity are commonly used to establish clinical trial inclusion criteria and may be based on several distinct assessment frameworks.⁵ It is also important to remember that these definitions capture severity at a given point in time and may not reflect the cumulative long-term burden of disease experienced by a patient.⁶

It is also important to consider disease extent when planning treatment in UC, as this may affect the optimal route of drug administration. This is typically defined according to disease involving the rectum only [proctitis], disease distal to the splenic flexure [left-sided or distal UC], or disease extending proximal to the splenic flexure [extensive UC].⁷ It should be noted that disease distribution can change⁴ and that proximal disease extension can be a negative prognostic marker.⁸

Publisher

European Crohn’s and Colitis Organisation

Guideline

Clinical Practice Guideline

Topics

IBD

Citation

Journal of Crohn's and Colitis, Volume 20, Issue 7, July 2026

Published

2026

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UEG Mistakes In Articles

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Mistakes in Familial Mediterranean Fever and how to avoid them

Manik Gemilyan, Gagik Hakobyan

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Abstract

Familial Mediterranean fever (FMF), also called periodic disease, Armenian disease, etc., is a prototypical autoinflammatory disorder where the underlying mechanism is the dysfunction of innate immunity, resulting in unprovoked episodes of inflammation.¹ Although considered rare worldwide, it is prevalent in people of Mediterranean origin; however, one can expect to encounter patients in all parts of the modern world. FMF is a monogenic disease with autosomal recessive inheritance.² Unlike other monogenic disorders, the diagnosis remains largely clinical, and it is important to understand the limitations of genetic testing. Another distinguishing feature is the well-established effectiveness of lifelong monotherapy with colchicine in preventing attacks and complications.³

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Primary Care

Published

2025

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UEG Mistakes In Articles

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Mistakes in inflammatory bowel disease and reproduction and how to avoid them

C. Janneke van der Woude, Shannon Kanis

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Abstract

Inflammatory bowel disease (IBD) is a chronic relapsing gastrointestinal disease, often affecting young people during their fertile years. The chronic character of IBD means that lifelong medical treatment is often required. As such, it is not surprising that questions often arise about fertility and pregnancy in patients with IBD. The most important risk factor for adverse pregnancy outcomes in IBD patients is the presence of disease activity during pregnancy. Indeed, negative pregnancy outcomes (e.g. spontaneous abortion, preterm delivery and low birth weight) are associated with disease activity at the time of conception and during pregnancy.

Topics

IBD Primary Care

Citation

Cite this article as: Kanis SL and van der Woude CJ. Mistakes in inflammatory bowel disease and reproduction and how to avoid them. UEG Education 2016: 16: 20–23.

Published

2024

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