Endoscopic Skipping of the Terminal Ileum in Pediatric Crohn Disease

Mansuri, Ishrat; Fletcher, Joel G.; Bruining, David H.; Kolbe, Amy B.; Fidler, Jeff L.; Samuel, Sunil; Tung, Jeanne

doi:10.2214/ajr.16.16575

Cited by 25 publications

(6 citation statements)

References 32 publications

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“…These features of CD lead to the need for SB imaging modalities like computed tomography enterography (CTE), magnetic resonance enterography (MRE), intestinal ultrasound (IUS), and capsule endoscopy (CE) [5,6], that have already been proven to alter management plans [7,8]. They should not be considered alternatives to ileocolonoscopy (IC) but complementary modalities able to detect proximal lesions [9]. These techniques are helpful in different settings in CD management, like in suspected CD, in patients with newly diagnosed CD, and in monitoring.…”

Section: Diagnostic Alternativesmentioning

confidence: 99%

Small bowel Crohn's disease: optimal modality for diagnosis and monitoring

Carretero¹

2022

Current Opinion in Gastroenterology

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Purpose of reviewThis paper reviews different imaging options for small bowel (SB) Crohn's disease (CD) patients.Recent findingsIn total, 80% of patients suffering from CD have SB involvement, being the exclusive manifestation in 30% of cases. As the proximal disease is related to poor response to treatment, a higher rate of stenosis and a greater need for surgical treatment, a SB assessment should be performed. This evaluation should be done not only once the disease has been diagnosed but periodically. The former to determine the extent of the disease, and the latter according to a treat-to-target strategy. Available techniques such as magnetic resonance imaging, intestinal ultrasound and capsule endoscopy (CE) have shown good accuracy parameters in CD patients. Cross-sectional studies are superior for penetrating and stricturing disease, whereas CE is excellent for proximal involvement and mucosal healing. Local expertise and availability may lead the election between techniques, nevertheless, they should not be considered as competitors but as complementary tools.SummarySB involvement in CD patients is frequent and related to poorer outcomes. Hence, SB evaluation should be screened after diagnosis and routinely during the follow-up.

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Section: Diagnostic Alternativesmentioning

confidence: 99%

Small bowel Crohn's disease: optimal modality for diagnosis and monitoring

Carretero¹

2022

Current Opinion in Gastroenterology

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“…One study did not find any significant correlation between the time to peak and the endoscopic indices. This might be because the endoscopist can only visualize the mucosal surface and not the entire bowel wall, referred to as endoscopic skipping [ 56 ]. In addition, the intestinal vascular remodeling that occurs in IBD is characterized by formation of stenotic neo microvessels and thus impaired mucosal perfusion [ 24 ].…”

Section: Contrast-enhanced Ultrasound For Adults With Inflammatory Bowel Diseasementioning

confidence: 99%

Contrast-enhanced ultrasound of the pediatric bowel

et al. 2021

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Contrast-enhanced ultrasound (CEUS) has emerged as a valuable modality for bowel imaging in adults and children. CEUS enables visualization of the perfusion of the bowel wall and of the associated mesentery in healthy and disease states. In addition, CEUS images can be used to make quantitative measurements of contrast kinetics, allowing for objective assessment of bowel wall enhancement. Bowel CEUS is commonly applied to evaluate inflammatory bowel disease and to monitor treatment response. It has also been applied to evaluate necrotizing enterocolitis, intussusception, appendicitis and epiploic appendagitis, although experience with these applications is more limited. In this review article, we present the current experience using CEUS to evaluate the pediatric bowel with emphasis on inflammatory bowel disease, extrapolating the established experience from adult studies. We also discuss emerging applications of CEUS as an adjunct or problem-solving tool for evaluating bowel perfusion. Electronic supplementary material The online version of this article (10.1007/s00247-020-04868-x) contains supplementary material, which is available to authorized users.

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“…A number of low-quality studies have demonstrated that completion of full ileocolonoscopy, including examination of the terminal ileum, is essential for the proper diagnosis and management of digestive diseases in most pediatric patients (51)(52)(53)(54). Incomplete or partial ileocolonoscopy, without inspection and tissue sampling of the ileocecal region, exposes pediatric patients to missed, misdiagnosed, and/or delayed diagnosis of IBD (55).…”

Section: 5%mentioning

confidence: 99%

Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopists and Endoscopists in Training

Walsh

Lightdale

Leibowitz

et al. 2021

J. pediatr. gastroenterol. nutr.

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Introduction: High-quality pediatric endoscopy requires reliable performance of procedures by competent individual providers who consistently uphold all standards determined to assure optimal patient outcomes. Establishing consensus expectations for ongoing monitoring and assessment of individual pediatric endoscopists is a method for confirming the highest possible quality of care for such procedures worldwide. We aim to provide guidance to define and measure quality of endoscopic care for children. Methods: With support from the North American and European Societies of Pediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN), an international working group of the Pediatric Endoscopy Quality Improvement Network (PEnQuIN) used the methodological strategy of the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument to develop standards and indicators relevant for assessing the quality of endoscopists. Consensus was sought via an iterative online Delphi process and finalized at an in-person conference. The quality of evidence and strength of recommendations were rated according to the GRADE (Grading of Recommendation Assessment, Development, and Evaluation) approach.Results: The PEnQuIN working group achieved consensus on 6 standards that all providers who perform pediatric endoscopy should uphold and 2 standards for pediatric endoscopists in training, with 7 corresponding indicators that can be used to identify high-quality endoscopists. Additionally, these can inform continuous quality improvement at the provider level. Minimum targets for defining high-quality pediatric ileocolonoscopy were set for 2 key indicators: cecal intubation rate (!90%) and terminal ileal intubation rate (!85%). Discussion: It is recommended that all individual providers performing or training to perform pediatric endoscopy initiate and engage with these international endoscopist-related standards and indicators developed by PEnQuIN.

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Endoscopic Skipping of the Terminal Ileum in Pediatric Crohn Disease

Abstract: Ileocolonoscopy may miss SB CD in pediatric patients that is due to isolated histologic, intramural, or proximal inflammation. Enterography is complementary to ileocolonoscopy in the evaluation of pediatric CD.

Cited by 25 publications

References 32 publications

Small bowel Crohn's disease: optimal modality for diagnosis and monitoring

Small bowel Crohn's disease: optimal modality for diagnosis and monitoring

Contrast-enhanced ultrasound of the pediatric bowel

Pediatric Endoscopy Quality Improvement Network Quality Standards and Indicators for Pediatric Endoscopists and Endoscopists in Training

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