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Background: Patients with inflammatory bowel disease (IBD) require accessible, timely, and noninvasive strategies to monitor disease. The aim was to assess the integration of intestinal ultrasound (IUS) on decision-making and endoscopy utilization in a standardized care pathway., Methods: This prospective, multicenter, international, observational cohort study included patients seen within a centralized model for IBD care was conducted during the COVID pandemic. Patients were evaluated with IUS alone or in combination with an in-clinic, unsedated sigmoidoscopy. Demographic, clinical, laboratory, and imaging data, clinical decisions, and need for urgent endoscopy, hospitalization, and surgeries were recorded., Results: Of the 158 patients included, the majority had an established diagnosis of Crohn's disease ( n  = 123, 78%), and 47% ( n  = 75) of patients were on biologic therapy. IUS identified active inflammation in 65% ( n  = 102) of patients, and strictures in 14% ( n  = 22). Fecal calprotectin levels correlated with inflammation detected on IUS (median of 50 μg/g [Q1-Q3: 26-107 μg/g] without inflammation and 270 μg/g [Q1-Q3: 61-556 μg/g] with inflammation; p  = 0.0271). In the majority of patients, clinical assessment with IUS led to an acute change in IBD-specific medications (57%, n  = 90) and avoided or delayed the need for urgent endoscopy (85%, n  = 134). Four patients were referred for urgent surgical consultation., Conclusions: Point-of-care IUS used in a flare clinic pathway is a useful strategy to improve effective IBD care delivery and to assist in therapeutic management decisions, in many cases avoiding the acute need for endoscopy., Competing Interests: K.L.N. reports advisory board fees from AbbVie, Janssen, Pfizer, Ferring; speaker’s fees from AbbVie, Janssen; and research support from AbbVie, Janssen. J.S., H.K., and J.H. report no conflicts. M.D. reports fees for participation on advisory committees from Amgen, Fresenius Kabi, Pendopharm, and Takeda; fees for participation on advisory committees from Bristol Myers Squibb, McKesson, Pendopharm, and Takeda; educational, clinical, or research grants from Abbvie, Amgen, Organon, Pfizer, Sandoz, and Takeda. T.M.G. reports support through provision of an Australian Government research training program scholarship and grant support from Janssen. R.J.M.I. reports travel support from AbbVie and speaker’s fees from Takeda. R.V.B. reports Grant/Research support/Speaker fees (all paid to employer for research support): AbbVie, Ferring, Janssen, Shire, Takeda, Emerge Health; shareholder in Biomebank. B.C. has served as a consultant and advisory board member, and received grants from AbbVie, Ferring, Janssen, Pfizer, Fresenius Kabi, Falk Pharama, Gilead, Celgene, and Takeda. R.V. has served as a consultant for Janssen. A.A.-A. was funded by scholarships from Crohn’s and Colitis Australia, Avant, the Australian Commonwealth Government, and University of Melbourne and received grants from the Gastroenterological Society of Australia/Celltrion Healthcare and Janssen. D.C. reports speaker’s fees and/or research support from Takeda, Janssen, Abbvie, and Tarp and consultancy fees from Takeda, Abbvie, and Taro. C.L. reports consulting or advisory board fees from AbbVie, Ferring, Janssen, and Takeda. C.M. reports consulting or advisory board fees from AbbVie, AVIR Pharma Inc, Janssen, Takeda, Pfizer, Roche, and Robarts Clinical Trials Inc.; speaker’s fees from AbbVie, Janssen, Takeda, and Pfizer., (© The Author(s) 2023. Published by Oxford University Press on behalf of Crohn's & Colitis Foundation.)