Assessment of stricturing Crohn's disease: Current clinical practice and future avenues

Abstract

Crohn's disease (CD) is a chronic remittent idiopathic disease. Although the early phase of the disease is commonly characterized by inflammation-driven symptoms, such as diarrhea, the frequency of fibrostenotic complications in patients with CD increases over the long-term course of the disease. This review presents the current diagnostic options for assessing CD-associated strictures. In addition to the endoscopic evaluation of CD strictures, this review summarizes the currently available imaging modalities, including ultrasound and cross-sectional imaging techniques. In addition to stricture detection, differentiating between the primarily inflammatory strictures and the predominantly fibrotic ones is essential for selecting the appropriate treatment strategy (anti-inflammatory medical treatment vs endoscopical or surgical approaches). Therefore, recent imaging advances, such as contrast-enhanced ultrasound and ultrasound elastography, contribute to the development of non-invasive non-radiating imaging of CD-associated strictures. Finally, novel magnetic resonance imaging techniques, such as diffusion-weighted, motility and magnetization transfer imaging, as well as (18)F-FDG PET/CT, molecular imaging approaches and biomarkers, are critically reviewed with regard to their potential role in assessing stricturing CD.

Usefulness of Strain Elastography, ARFI Imaging, and Point Shear Wave Elastography for the Assessment of Crohn Disease Strictures

“…To date, the detection and management of Crohn inflammatory lesions has been well established, but the discovery and diagnosis of fibrosis is lagging behind; hence, there remains no effective drug to prevent intestinal fibrosis . In terms of Crohn disease imaging, abdominal intestinal ultrasonography is a commonly accepted method for detecting thickened bowel walls, vascularization signals, stratification patterns, and extramural lesions . In addition, the emerging technology of ultrasound elastography of the intestinal tract is opening a new direction for research.…”

“…Inflammation or fibrosis is always responsible for strictures in Crohn disease, resulting in bowel wall thickening and luminal narrowing . Determining the predominant type of stenosis (inflammatory or fibrotic) is relevant for the patient's clinical treatment schedule, as the former is generally responsive to medical therapies, whereas fibrosis traditionally is believed to be nonresponsive and requires endoscopic dilatation or surgical treatment …”

Feasibility of CEUS and strain elastography in one case of ileum Crohn stricture and literature review

“…Contrast enhanced MRI enterography has a late interstitial phase which is useful for detecting moderate or severe fibrosis of the bowel wall [14]. Contrast enhanced MRI enterography is in clinical practice considered the gold standard for the diagnosis and monitoring of small-bowel Crohn's disease due to the high diagnostic accuracy [15,16]. However, according to the recent review of Bettenworth et al, also CEUS and SE seem to be promising, and a combination of these two methods could improve stricture characterization in Crohn's disease [16].…”

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

“…CT or MR enterography are considered the gold standard techniques for assessment of small bowel disease. Both techniques, in addition to inflammatory markers, are useful in distinguishing inflammatory from fibrostenotic disease which is important as inflammatory strictures are more likely to respond to medical therapy whereas fibrotic disease is likely to require mechanical treatment .…”