Systematic review: Defining, diagnosing and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound

Cathy Lu; Ryan Rosentreter; Maxime Delisle; Mattie White; Claire E Parker; Zahra Premji; Stephanie R Wilson; Mark E Baker; Gauraang Bhatnagar; Jakob Begun; David H Bruining; Robert Bryant; Britt Christensen; Brian G Feagan; Joel G Fletcher; Vipul Jairath; John Knudsen; Torsten Kucharzik; Christian Maaser; Giovanni Maconi; Kerri Novak; Jordi Rimola; Stuart A Taylor; Rune Wilkens; Florian Rieder; Stenosis Therapy and Anti‐Fibrotic Research (STAR) consortium

doi:10.1111/apt.17918

Systematic review: Defining, diagnosing and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound

Aliment Pharmacol Ther. 2024 Apr;59(8):928-940. doi: 10.1111/apt.17918. Epub 2024 Mar 4.

Authors

Cathy Lu¹, Ryan Rosentreter¹, Maxime Delisle², Mattie White³, Claire E Parker⁴, Zahra Premji⁵, Stephanie R Wilson^{1

6}, Mark E Baker⁷, Gauraang Bhatnagar^{8

9}, Jakob Begun¹⁰, David H Bruining¹¹, Robert Bryant¹², Britt Christensen¹³, Brian G Feagan^{4

14}, Joel G Fletcher¹⁵, Vipul Jairath^{4

14

16}, John Knudsen¹⁵, Torsten Kucharzik¹⁷, Christian Maaser¹⁸, Giovanni Maconi¹⁹, Kerri Novak¹, Jordi Rimola²⁰, Stuart A Taylor⁸, Rune Wilkens^{21

22}, Florian Rieder^{3

23

24}; Stenosis Therapy and Anti‐Fibrotic Research (STAR) consortium

Affiliations

¹ Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
² Department of Medicine, Division of Gastroenterology, Université de Sherbrooke, Sherbrooke, Quebec, Canada.
³ Department of Gastroenterology, Hepatology & Nutrition; Digestive Diseases and Surgery Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
⁴ Alimentiv Inc., London, Ontario, Canada.
⁵ Libraries, University of Victoria, Victoria, British Columbia, Canada.
⁶ Department of Radiology, University of Calgary, Calgary, Alberta, Canada.
⁷ Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA.
⁸ Centre for Medical Imaging, University College London, London, UK.
⁹ Frimley Health NHS Foundation Trust, Surrey, UK.
¹⁰ Department of Gastroenterology, Mater Hospital, Brisbane, Queensland, Australia.
¹¹ Department of Gastroenterology, Queen Elizabeth Hospital, Adelaide, South Australia.
¹² Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.
¹³ Department of Gastroenterology, Royal Melbourne Hospital and University of Melbourne, Melbourne, Victoria, Australia.
¹⁴ Department of Medicine, University of Western Ontario, London, Ontario, Canada.
¹⁵ Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA.
¹⁶ Department of Epidemiology and Biostatistics, Department of Medicine, Western University, London, Ontario, Canada.
¹⁷ Department of General Internal Medicine and Gastroenterology, University Teaching Hospital Lüneburg, Lüneburg, Germany.
¹⁸ Outpatients' Department of Gastroenterology, University Teaching Hospital Lüneburg, Lüneberg, Germany.
¹⁹ Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
²⁰ IBD Unit, Radiology Department, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain.
²¹ Digestive Disease Center, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark.
²² Copenhagen Intestinal Ultrasound, Bispebjerg Hospital, Copenhagen, Denmark.
²³ Cleveland Clinic Center for Global Translational Inflammatory Bowel Diseases, Cleveland, Ohio, USA.
²⁴ Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.

PMID: 38436124
DOI: 10.1111/apt.17918

Abstract

Background: Stricturing Crohn's disease (CD) occurs most commonly in the terminal ileum and poses a clinical problem. Cross-sectional imaging modalities such as intestinal ultrasound (IUS), computed tomography enterography (CTE), and magnetic resonance enterography (MRE) allow for assessment of the entire bowel wall and associated peri-enteric findings. Radiologic definitions of strictures have been developed for CTE and MRE; their reliability and responsiveness are being evaluated in index development programs. A comprehensive assessment strategy for strictures using IUS is needed.

Aims: To provide a detailed summary of definitions, diagnosis and monitoring of strictures on IUS as well as technical aspects of image acquisition.

Methods: We searched four databases up to 6 January 2024. Two-stage screening was done in duplicate. We assessed risk of bias using QUADAS-2.

Results: There were 56 studies eligible for inclusion. Definitions for strictures on IUS are heterogeneous, but the overall accuracy for diagnosis of strictures is high. The capability of IUS for characterising inflammation versus fibrosis in strictures is not accurate enough to be used in clinical practice or trials. We summarise definitions for improvement of strictures on IUS, and discuss parameters for image acquisition and standardisation.

Conclusions: This systematic review is the first step for a structured program to develop a stricture IUS index for CD.

Publication types

Systematic Review
Review

MeSH terms

Constriction, Pathologic / diagnostic imaging
Constriction, Pathologic / pathology
Crohn Disease* / diagnosis
Crohn Disease* / diagnostic imaging
Humans
Intestinal Obstruction*
Intestines / pathology
Magnetic Resonance Imaging / methods
Reproducibility of Results