The role of small bowel endoscopy for Crohn's disease

Zammit, Stefania Chetcuti; Ellul, Pierre; Sidhu, Reena

doi:10.1097/mog.0000000000000519

“…Histological diagnosis is desirable, nevertheless up to 58% of patients with DAE findings consistent with CD have normal or nonspecific histology [32]. So, when finding typical lesions of CD in CE, empirical treatment may be acceptable after excluding non-steroidal antiinflammatory drug use and infective diseases [33]. Due to the invasive nature of DAE, we suggest performing it when CE findings are not clear (3 or more ulcers) [34] or when a second CE performed after six months of treatment shows no response.…”

Section: Suspected Crohn's Diseasementioning

confidence: 99%

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

Carretero¹

2022

Current Opinion in Gastroenterology

2

0

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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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“…Small bowel capsule endoscopy allows the direct visualization of the mucosal surface, which is of great value for monitoring disease activity. Additionally, the inability to biopsy and the potential risk of retention limit its value [ 17 ]. In contrast, double-balloon enteroscopy (DBE) is notably superior to CT and capsule endoscopy in the differential diagnosis of intraluminal small bowel diseases [ 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Differentiation of Isolated Small Bowel Crohn’s Disease from Other Small Bowel Ulcerative Diseases: Clinical Features and Double-Balloon Enteroscopy Characteristics

Niu

¹

,

Chen

²

,

Li

³

et al. 2022

Gastroenterology Research and Practice

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Background. The diagnosis of isolated small bowel Crohn’s disease (ISBCD) has always been challenging. Aims. This study is aimed at comparing the clinical features and double-balloon enteroscopy (DBE) characteristics of ISBCD with those of other small bowel ulcerative diseases (OSBUD). Methods. Patients with coexisting colonic and/or ileal valve lesions ( n = 45 ) or whose final diagnosis was not determined ( n = 29 ) were excluded. One hundred thirty-nine patients with ISBCD and 62 patients with OSBUD found by DBE were retrospectively analyzed. Results. The age of ISBCD onset was lower than that of OSBUD (OR 0.957, 95% CI 0.938-0.977, p < 0.001 ). Abdominal pain was more common in ISBCD (OR 4.986, 95% CI 2.539-9.792, p < 0.001 ). Elevated fibrinogen levels (OR 1.431, 95% CI 1.022-2.003, p = 0.037 ) and lower levels of D-dimer (OR 0.999, 95% CI 0.999-1.000, p = 0.017 ) were also more supportive of the diagnosis of ISBCD. Nonsteroidal anti-inflammatory drugs (NSAIDs) used for more than two weeks decreased the probability of a diagnosis of ISBCD (OR 0.173, 95% CI 0.043-0.695, p = 0.013 ). Abdominal computed tomography revealed a higher proportion of skip lesions in ISBCD than in OSBUD (OR 9.728, 95% CI 3.676-25.742, p < 0.001 ). The ulcers of ISBCD were more distributed in the ileum (111 (79.9%) vs. 29 (46.8%), p < 0.001 ), and their main morphology differed in different intestinal segments. Longitudinal ulcers (OR 14.293, 95% CI 4.920-41.518, p < 0.001 ) and large ulcer (OR 0.128, 95% CI 0.044-0.374, p < 0.001 ) contributed to the differentiation of ISBCD from OSBUD. We constructed a diagnostic model, ISBCD index ( AUROC = 0.877 , 95% CI: 0.830-0.925), using multifactorial binary logistic regression to help distinguish between these two groups of diseases. Conclusion. Clinical features, laboratory tests, abdominal computed tomography, DBE characteristics, and pathology help to distinguish ISBCD from OSBUD.

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“…Another example of a limit in this technique is the detection of fistulas. They are frequently omitted, and biopsies do not tend to reach sufficiently deep into the bowel wall [ 11 , 12 , 13 ]. Although all imaging diagnostic methods can find inflammatory processes based on the increased after-contrast vascularisation, detecting bowel fibrosis remains a diagnostic challenge.…”

Section: Introductionmentioning

confidence: 99%

Shear Wave and Strain Elastography in Crohn’s Disease—A Systematic Review

Grażyńska

¹

,

Kufel

²

,

Dudek

³

et al. 2021

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One modern imaging technique used in the diagnosis of Crohn’s disease (CD) is sonoelastrography of the intestine. Guidelines regarding the use of bowel sonoelastography in CD have still not been specified. The aim of our research was to conduct a systematic review of the use of sonoelastography in the diagnosis, assessment, and monitoring of strictures in the course of CD. A systematic review was conducted according to the PRISMA guidelines statement. The following databases were searched in January 2021: MEDINE via PubMed, Embase and Scopus. The search utilised the following MeSH tags: ‘Ultrasound Shear Wave’, ‘Elastography’, ‘elastogram’, ‘elastographies’ AND ‘Crohn disease’. The inclusion criteria were as follows: from 2010 or later, articles with abstracts, articles in English, human-based studies and original articles. Articles were assessed independently by two reviewers. Out of 181 articles, only 15 met the criteria and were included in the review. Due to a small number of studies and significant methodological differences, the feasibility of using sonoelastography for Crohn’s disease must be proven through further research and analysis. In the future, standardised assessment criteria and cut-off points should be established for both strain elastography (SE) and shear wave elastography (SWE).

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The role of small bowel endoscopy for Crohn's disease

Cited by 8 publications

References 118 publications

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

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

Differentiation of Isolated Small Bowel Crohn’s Disease from Other Small Bowel Ulcerative Diseases: Clinical Features and Double-Balloon Enteroscopy Characteristics

Shear Wave and Strain Elastography in Crohn’s Disease—A Systematic Review

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