Usefulness of Intestinal Ultrasound to Detect Small Intestinal Stenosis in Patients With Crohn's Disease

Abstract

Objectives-Double balloon enteroscopy (DBE) with retrograde contrast is useful as a monitoring tool for small intestinal lesions in Crohn's disease (CD), but these are burdensome for patients. Intestinal ultrasound (IUS) can be used with ease in daily clinical practice, but there is less evidence regarding the accuracy of detection of small intestinal stenosis in CD. This study aimed to examine the diagnostic power of IUS for small intestinal stenosis in patients with CD.Methods-The findings of DBE and IUS in 86 patients with CD with small intestinal lesions were evaluated. Using DBE as the reference standard, we examined the detection rate of IUS for small intestinal stenosis. We evaluated three parameters: luminal narrowing, prestenotic dilation, and to-and-fro movement for determining stenosis using IUS. In addition, we compared the characteristics between the stenosis-detectable and stenosis-undetectable groups by IUS.Results-Of the 86 patients, 30 had small intestinal stenosis. In IUS findings, when lesions that met two or more of the three parameters were judged as stenosis, the detection rate was 70.0% for sensitivity, 98.2% for specificity, and 88.4% for accuracy. Moreover, there were patients with a younger age at diagnosis (P < 0.05) and more ileocolonic disease location (P < 0.05) in the stenosisdetectable group by IUS. The stenoses detected by IUS were significantly longer than those undetected by IUS (14.1 mm versus 5.2 mm, P < 0.05).Conclusions-IUS delivered reliable results for clinically important small intestinal stenosis of CD with high diagnostic accuracy.

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

“…Despite considerable variability in definitions and methodology, the accuracy for stricture diagnosis was high regardless of the gold standard definition used. 6,40 These findings are consistent with observations made on CTE or MRE. 72 To date, no studies have evaluated the diagnostic accuracy of IUS for the evaluation of proximal small bowel strictures; the largest body of evidence exists for strictures situated in the TI.…”

Letter to the Editor on “Usefulness of Intestinal Ultrasound to Detect Small Intestinal Stenosis in Patients With Crohn's Disease”

“…We read with interest the article by Dr Takeuchi et al entitled "Usefulness of intestinal ultrasound to detect small intestinal stenosis in patients with Crohn's disease" recently published in Journal of Ultrasound in Medicine (2023;42:373-383). 1 We agree basically with the authors, since many of these suggestions are widely shareable. However, there remain some questions; 1) the definition of luminal stenosis is not strictly presented (eg, in Figure 2, without arrow (A) it is very difficult to recognize the luminal stenosis point).…”

“…Early detection of this complication is important to minimize surgery. We read with interest the article by Dr Takeuchi et al entitled “Usefulness of intestinal ultrasound to detect small intestinal stenosis in patients with Crohn's disease” recently published in Journal of Ultrasound in Medicine (2023;42:373–383) 1 . We agree basically with the authors, since many of these suggestions are widely shareable.…”

“…We have read with great interest the article by Takeuchi et al, titled “Usefulness of intestinal ultrasound to detect small intestinal stenosis in patients with Crohn's disease.” 1 …”

“…We have read with great interest the article by Takeuchi et al, titled "Usefulness of intestinal ultrasound to detect small intestinal stenosis in patients with Crohn's disease." 1 Crohn's disease is a progressive transmural intestinal inflammatory disease, frequently associated with intestinal stenosis. Early detection of this complication is important to minimize surgery.…”