Use of small bowel MRI enteroclysis in the management of paediatric IBD

Abstract

Within our setup, MR enteroclysis is a well-tolerated, sensitive technique for small bowel imaging, providing detailed information at crucial clinical decision points. Moreover, accurate information then allows appropriate clinical decisions to be made.

Particularities of Crohn’s disease in pediatric patients: current status and perspectives regarding imaging modalities

“…Since the bowel loops need to be distended in order to detect changes in the luminal diameter, the most accurate results can be achieved with the magnetic resonance enteroclysis (contrast via tube placement) or MRE (contrast intake orally) techniques [157,158]. Due to its lack of ionizing radiation, good image quality and excellent soft-tissue contrast resolution, it is considered nowadays as the first choice imaging modality in pediatric patients with IBD and its importance is increasing [2,20].…”

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in surgery for inflammatory bowel disease

“…There are data confirming that colorectal surgeons whose main practice is in treating adults can provide safe and effective surgical care to adolescent patients when working within a paediatric IBD multidisciplinary team [740,741]. [742]. In an adolescent with limited symptomatic ileocaecal Crohn's disease, it is reasonable to discuss as a multidisciplinary team the option of surgery at the time of considering escalation to biological therapy, as there are rare but potentially significant complications of anti-TNF therapy in the adolescent population, namely hepatosplenic T-cell lymphoma [743], and it may be appropriate to leave biological therapy for later in adult life when the disease recurs.…”

“…The main indications for surgery are stricture formation, medically resistant disease and perforating/fistulizing disease. Use of small bowel MRI enteroclysis provides detailed anatomical and disease‐specific information, and aids clinical decision‐making when considering surgical intervention . In an adolescent with limited symptomatic ileocaecal Crohn's disease, it is reasonable to discuss as a multidisciplinary team the option of surgery at the time of considering escalation to biological therapy, as there are rare but potentially significant complications of anti‐TNF therapy in the adolescent population, namely hepatosplenic T‐cell lymphoma , and it may be appropriate to leave biological therapy for later in adult life when the disease recurs.…”

Radiation exposure in children with inflammatory bowel disease

“…These studies complement many adult studies that demonstrate the utility of MRE in detecting active bowel inflammation often beyond the reach of standard endoscopy. Furthermore, MRE has the ability to identify intra-abdominal complications and has been demonstrated for use in decision making in pediatric IBD [32].…”