|
1
|
Kleemann T, Freund R, Braden B, Hocke M, Hollerbach S, Jenssen C, Möller K, Dong Y, Bhutani MS, Kitano M, Sun S, El-Lehibi A, Dietrich CF. An international survey on the geographical differences in practice patterns and training of endoscopic ultrasound. J Transl Int Med 2025; 13:48-64. [PMID: 40115033 PMCID: PMC11921813 DOI: 10.1515/jtim-2025-0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2025] Open
Abstract
Background and Objectives Recently, a series of publications discuss what kind of clinical and technical information is important to know before performing endoscopic ultrasound (EUS) examinations. This paper aims to investigate variations in the performance of EUS examinations in different countries worldwide to present views and experiences on the use of pre-EUS investigations. Methods In a multinational and multidisciplinary survey, more than 100 practicing EUS endoscopists were surveyed by a questionnaire asking for their level of education and training, their experience in diagnostic and therapeutic procedures, preferred technical use and procedural steps before EUS examination. Substantial geographic variation not only in the level of training and mandatory imaging prior to EUS, but consequently also in the standards and practice of EUS examinations and advanced EUS guided therapeutic procedures were observed. The participants' preferences regarding technical use and procedural steps prior to EUS examinations were assessed according to their level of education and training experience. Results Transabdominal ultrasound (TUS) is performed prior to EUS by the EUS endoscopists themselves in most European countries but not in North and South Americas where non-invasive pre-EUS imaging is delegated to other specialties such as radiology. Different training backgrounds, cultural beliefs, infrastructures, available equipment and access to training programs have a strong impact on the EUS workforce and EUS procedural practice across the continents. Conclusions The study results suggest existence of relevant geographical differences that reflect not only the different levels of education in different settings but also differences regarding technical standards for the performance of EUS and TUS examinations worldwide.
Collapse
Affiliation(s)
- Tobias Kleemann
- Department of Gastroenterology and Rheumatology, Carl-Thiem-Hospital Cottbus, Cottbus 03048, Germany
| | - Robert Freund
- Thiem Research, Carl-Thiem-Hospital Cottbus, Cottbus 03048, Germany
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK
- Medical Department B, University of Muenster, Muenster 48149, Germany
| | - Michael Hocke
- Department of Internal Medicine II, Helios Hospital Meiningen, Meiningen 98617, Germany
| | - Stephan Hollerbach
- Department of Medicine and Gastroenterology, Allgemeines Krankenhaus, Celle 29223, Germany
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Märkisch Oderland, Strausberg 15344, Germany
- Brandenburg Institute for Clinical Ultrasound, Medical University Brandenburg, Neuruppin 16816, Germany
| | - Kathleen Möller
- Medical Department I/Gastroenterology, Sana Hospital Lichtenberg, Berlin 10365, Germany
| | - Yi Dong
- Department of Ultrasound, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Manoop Singh Bhutani
- Department of Gastroenterology, Hepatology, Nutrition, UT MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Masayuki Kitano
- Department of Internal Medicine, Wakayama Medical University, Wakayama 641-0012, Japan
| | - Siyu Sun
- Endoscopy Center, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Abed El-Lehibi
- Gastroenterology & Hepatology Department, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Christoph Frank Dietrich
- Department of Internal Medicine, Clinics Beau-Site, Salem, and Permanence, Bern 3013, Switzerland
| |
Collapse
|
|
2
|
Shankar N, Kuo L, Krugliak Cleveland N, Galen B, Samel NS, Perez-Sanchez A, Nathanson R, Coss E, Echavarria J, Rubin DT, Soni NJ. Point-of-Care Ultrasound in Gastroenterology and Hepatology. Clin Gastroenterol Hepatol 2025:S1542-3565(25)00019-9. [PMID: 39793722 DOI: 10.1016/j.cgh.2024.09.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2024] [Revised: 09/17/2024] [Accepted: 09/30/2024] [Indexed: 01/13/2025]
Abstract
Point-of-care ultrasound (POCUS) is changing the practice of nearly all specialties and is increasingly being incorporated as a bedside tool by more gastroenterologists and hepatologists. POCUS is most often used to answer focused diagnostic questions, supplement the traditional physical examination, and guide performance of invasive bedside procedures. This review describes several common POCUS applications used in gastroenterology and hepatology, as well as some novel applications that warrant further investigation.
Collapse
Affiliation(s)
- Nagasri Shankar
- Division of Gastroenterology and Hepatology, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Lily Kuo
- Division of Gastroenterology and Hepatology, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | | | - Benjamin Galen
- Division of Hospital Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Nicholas S Samel
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York
| | - Ariadna Perez-Sanchez
- Division of Hospital Medicine, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Robert Nathanson
- Division of Hospital Medicine, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas; Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Elizabeth Coss
- Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas
| | - Juan Echavarria
- Division of Gastroenterology and Hepatology, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - David T Rubin
- University of Chicago Medicine IBD Center, Chicago, Illinois
| | - Nilam J Soni
- Division of Hospital Medicine, Joe R. Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas; Medicine Service, South Texas Veterans Health Care System, San Antonio, Texas; Division of Pulmonary Diseases and Critical Care Medicine, Joe R. and Teresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, Texas.
| |
Collapse
|
|
3
|
Dietrich CF, Möller K. [Imaging in chronic inflammatory bowel disease]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2025; 66:40-54. [PMID: 39704791 DOI: 10.1007/s00108-024-01831-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2024] [Indexed: 12/21/2024]
Abstract
In patients with chronic inflammatory bowel disease (IBD), endoscopic techniques (including capsule techniques and balloon enteroscopy for the small intestine), ultrasound (US), computed tomography (CT) and magnetic resonance imaging (MRI) are primarily used as often complementary imaging techniques. Radiation exposure needs to be kept in mind when using CT and conventional X‑ray-techniques. Therefore, most importantly, ultrasound and MRI have changed the routine diagnostics of intestinal diseases. US, CT and MRI not only assess the lumen but, similarly importantly, also the wall and the surrounding structures of the gastrointestinal tract. Furthermore, functional processes can be visualized and provide important information about passage and perfusion, which is mainly true for real-time ultrasound. CT and MRI are usually carried out with the use of contrast agents as contrast-enhanced CT (CECT) and contrast-enhanced MRI (CEMRI). Ultrasound is performed conventionally or with intravascular (CEUS) and/or extravascular intracavitary contrast agent application (icCEUS). This article provides an overview of the current significance of the mentioned imaging procedures in patients with IBD and discusses the typical indications.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Departement Allgemeine Innere Medizin (DAIM), Kliniken Hirslanden Bern Beau-Site, Salem und Permanence, Bern, Schweiz.
| | - Kathleen Möller
- Innere Medizin I, Schwerpunkt Gastroenterologie, Sana Klinikum Lichtenberg, Berlin, Deutschland.
| |
Collapse
|
|
4
|
Terracciano F, Marra A, Nassisi V, Lillo C, Bossa F, Carparelli S, Cocomazzi F, Valvano MR, Losurdo G, Di Leo A, Perri F. Ultrasound Features of Helicobacter pylori-Related Gastritis. Antibiotics (Basel) 2024; 14:12. [PMID: 39858298 PMCID: PMC11763164 DOI: 10.3390/antibiotics14010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2024] [Revised: 12/09/2024] [Accepted: 12/18/2024] [Indexed: 01/27/2025] Open
Abstract
Background Abdominal ultrasound (US) is a reliable method for visualizing gastric wall layers and measuring their thickness. The objective of this study is to characterize the ultrasound features of H. pylori-induced gastritis and assess its predictive potential role for this condition. Methods A cohort of 119 patients underwent gastroscopy with biopsy and abdominal US to evaluate antral wall thickness (AWT), submucosal wall thickness (SLT), mucosal wall thickness (MLT), gastric motility, and the presence of ingested material. They were divided into three groups: group A (normal mucosa without H. pylori infection), group B (gastritis H. pylori negative) and group C (gastritis H. pylori positive). Results: SLT and reduced gastric motility were significantly increased in the H. pylori gastritis group (p < 0.001). Multivariate analysis identified SLT as the only significant independent predictor of H. pylori gastritis (p < 0.001). An SLT threshold of 1.55 mm was determined as optimal for differentiating H. pylori-positive patients from -negative, yielding a sensitivity of 77% and a specificity of 72%. Conclusions These findings suggest that H. pylori gastritis is characterized by submucosal layer thickening and impaired gastric motility.
Collapse
Affiliation(s)
- Fulvia Terracciano
- Division of Gastroenterology & Endoscopy, IRCCS, Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (C.L.); (F.B.); (S.C.); (F.C.); (F.P.)
| | - Antonella Marra
- Division of Gastroenterology & Endoscopy, IRCCS, Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (C.L.); (F.B.); (S.C.); (F.C.); (F.P.)
- National Institute of Gastroenterology, IRCCS Saverio de Bellis Research Hospital, 70013 Castellana Grotte, Italy
| | - Veronica Nassisi
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Chiara Lillo
- Division of Gastroenterology & Endoscopy, IRCCS, Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (C.L.); (F.B.); (S.C.); (F.C.); (F.P.)
| | - Fabrizio Bossa
- Division of Gastroenterology & Endoscopy, IRCCS, Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (C.L.); (F.B.); (S.C.); (F.C.); (F.P.)
| | - Sonia Carparelli
- Division of Gastroenterology & Endoscopy, IRCCS, Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (C.L.); (F.B.); (S.C.); (F.C.); (F.P.)
| | - Francesco Cocomazzi
- Division of Gastroenterology & Endoscopy, IRCCS, Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (C.L.); (F.B.); (S.C.); (F.C.); (F.P.)
| | - Maria Rosa Valvano
- Quality and Accreditation Unit, IRCCS, Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
| | - Giuseppe Losurdo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy (A.D.L.)
| | - Alfredo Di Leo
- Section of Gastroenterology, Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, 70124 Bari, Italy (A.D.L.)
| | - Francesco Perri
- Division of Gastroenterology & Endoscopy, IRCCS, Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (C.L.); (F.B.); (S.C.); (F.C.); (F.P.)
| |
Collapse
|
|
5
|
Brodersen JB, Rafaelsen SR, Juel MA, Knudsen T, Kjeldsen J, Jensen MD. Assessment of Treatment Response in Known Crohn's Disease-A Prospective Blinded Study Comparing the Diagnostic Accuracy of Intestinal Ultrasound, Magnetic Resonance Enterocolonography, Panenteric Capsule Endoscopy, and Fecal Calprotectin. Inflamm Bowel Dis 2024:izae254. [PMID: 39495122 DOI: 10.1093/ibd/izae254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Indexed: 11/05/2024]
Abstract
BACKGROUND Minimally invasive modalities may replace ileocolonoscopy (IC) in the follow-up of Crohn's disease (CD). The aim of this study was to evaluate intestinal ultrasound (IUS), magnetic resonance enterocolonography (MREC), panenteric capsule endoscopy (PCE), and fecal calprotectin (FC) for determining response to medical treatment in patients with ileocolonic CD. METHODS This prospective, blinded, multicenter study included patients with endoscopically active CD. Patients were scheduled for IC, MREC, IUS, PCE, and FC before and 12 weeks after treatment with corticosteroids or biological therapy. A ≥50% reduction of the Simple Endoscopic Score for Crohn's Disease (SES-CD) with IC defined treatment response. RESULTS Fifty patients completed the pre- and posttreatment evaluation with IC, and endoscopic response was achieved in 25 (50.0%). PCE was omitted in 12 (24.0%) patients because of stricturing CD. All activity scores decreased in patients achieving endoscopic response: The Simple Ultrasound Score for Crohn's Disease 2.2 vs 6.1 (P < .001), Magnetic Resonance Index of Activity 29.0 vs 37.1 (P = .05), SES-CD with PCE 3.1 vs 12.8 (P < .001), and FC 115.3 vs 1339.9 mg/kg (P < .001). The sensitivity and specificity of IUS, MREC, PCE, and FC were 80.0% (95% CI, 56.3-94.3)/77.8% (95% CI, 52.4-93.6), 65.2% (95% CI, 42.7-83.6)/87.0% (95% CI, 66.4-97.2), 87.5% (95% CI, 61.7-98.4)/86.7% (95% CI, 59.5-98.3), and 90.0% (95% CI, 68.3-98.8)/86.4% (95% CI, 65.1-97.1), respectively. CONCLUSIONS IUS and FC are equally effective for determining treatment response in patients with active CD. PCE is limited by the occurrence of strictures in this group of patients.
Collapse
Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Region of Southern Denmark, Denmark
| | - Søren Rafael Rafaelsen
- Department of Regional Health Research, University of Southern Denmark, Region of Southern Denmark, Denmark
- Department of Radiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Mie Agerbæk Juel
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Torben Knudsen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Region of Southern Denmark, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- OPEN Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Michael Dam Jensen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Region of Southern Denmark, Denmark
| |
Collapse
|
|
6
|
Chong VH. Gastric Carcinomas and Point-of-Care Ultrasound (POCUS): A Report of Two Cases. Cureus 2024; 16:e73869. [PMID: 39697947 PMCID: PMC11655047 DOI: 10.7759/cureus.73869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2024] [Indexed: 12/20/2024] Open
Abstract
Stomach cancer remains a significant cause of mortality, as most patients are diagnosed at advanced stages. The primary method for diagnosis is endoscopy, along with tissue acquisition, supplemented by endoscopic ultrasound or computed tomography for disease staging. While point-of-care ultrasound (POCUS) is now firmly integrated into clinical practice, it is still not widely utilized. POCUS can be performed at the initial point of contact and provides instant information that can influence investigation strategies. We report two cases of gastric antral carcinoma detected by POCUS, which led to targeted investigations. Both patients underwent expedited upper gastrointestinal endoscopies that confirmed distal gastric carcinoma. These cases highlight the important role of POCUS in triaging patients for timely and appropriate targeted organ investigations.
Collapse
Affiliation(s)
- Vui H Chong
- Department of Medicine, RIPAS Hospital, Bandar Seri Begawan, BRN
| |
Collapse
|
|
7
|
Lipan LE, Ioanitescu S, Enache AO, Saftoiu A, Tanase AD. Is Contrast-Enhanced Ultrasonography a New, Reliable Tool for Early-Graft-versus-Host Disease Diagnosis? J Clin Med 2024; 13:6065. [PMID: 39458018 PMCID: PMC11508394 DOI: 10.3390/jcm13206065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2024] [Revised: 10/02/2024] [Accepted: 10/04/2024] [Indexed: 10/28/2024] Open
Abstract
Acute gastrointestinal graft-versus-host disease (GI aGVHD) is a significant and life-threatening complication in patients undergoing allogeneic stem cell transplantation (allo-SCT). Early diagnosis of GI aGVHD is crucial for improving patient outcomes, but it remains a challenge due to the condition's nonspecific symptoms and the reliance on invasive diagnostic methods, such as biopsies and endoscopic procedures. In recent years, interest in non-invasive diagnostic techniques for graft-versus-host disease has increased, with contrast-enhanced ultrasound (CEUS) being one of them. For this reason, we aimed to examine the potential of ultrasound as a non-invasive, safe, and cost-effective alternative for the early detection and monitoring of GI aGVHD in this review. Our narrative review aims to describe the use of multimodal US that includes conventional US (B-mode and Doppler US) and advanced ultrasound techniques such as CEUS and CRTE for the non-invasive diagnosis of GI GVHD. We browsed several databases, including PubMed, Scopus, Web of Science, and Google Scholar. The search spanned 2000 to the present, focusing on articles written in English that reviewed the use of these imaging techniques in the context of GI GVHD. Following our research, we noticed that CEUS offers several advantages, including the real-time visualization of the gastrointestinal wall, assessment of blood flow, and detailed microvascular analysis-all achieved without the use of ionizing radiation. This feature makes CEUS an appealing option for repeated assessments, which are often necessary in monitoring the progression of GI aGVHD. When used in conjunction with conventional gastrointestinal ultrasound (GIUS), CEUS provides a more comprehensive view of the structural and functional changes occurring in the GI tract, potentially enhancing diagnostic accuracy and allowing for earlier intervention. In comparison to traditional diagnostic methods like tissue biopsy or CT scans, CEUS is less invasive, quicker to perform, and better tolerated by patients, especially those in fragile health following allo-SCT. Its non-invasive nature and ability to provide immediate imaging results make it a valuable tool for clinicians, particularly in settings where minimizing patient discomfort and risk is paramount. However, despite these advantages, there are still gaps in the literature regarding CEUS's full diagnostic accuracy for GI aGVHD. Further research, including larger clinical trials and comparative studies, is needed to validate CEUS's role in routine clinical practice and to establish standardized protocols for its use. Nonetheless, CEUS shows considerable potential to transform the diagnostic approach to GI aGVHD by improving early detection, reducing the need for invasive procedures, and ultimately enhancing treatment outcomes for affected patients.
Collapse
Affiliation(s)
- Lavinia-Eugenia Lipan
- University of Pharmacy and Medicine “Carol Davila”, 020021 Bucharest, Romania; (S.I.); (A.-O.E.); (A.S.); (A.D.T.)
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Simona Ioanitescu
- University of Pharmacy and Medicine “Carol Davila”, 020021 Bucharest, Romania; (S.I.); (A.-O.E.); (A.S.); (A.D.T.)
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| | - Alexandra-Oana Enache
- University of Pharmacy and Medicine “Carol Davila”, 020021 Bucharest, Romania; (S.I.); (A.-O.E.); (A.S.); (A.D.T.)
| | - Adrian Saftoiu
- University of Pharmacy and Medicine “Carol Davila”, 020021 Bucharest, Romania; (S.I.); (A.-O.E.); (A.S.); (A.D.T.)
- Department of Gastroenterology and Hepatology, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Alina Daniela Tanase
- University of Pharmacy and Medicine “Carol Davila”, 020021 Bucharest, Romania; (S.I.); (A.-O.E.); (A.S.); (A.D.T.)
- Fundeni Clinical Institute, 022328 Bucharest, Romania
| |
Collapse
|
|
8
|
Aprile F, Vangeli M, Allocca M, Zilli A, Argollo MC, D’amico F, Parigi TL, Danese S, Furfaro F. Gastrointestinal Ultrasound in Infectious Diseases: A Comprehensive Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1402. [PMID: 39336443 PMCID: PMC11434242 DOI: 10.3390/medicina60091402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/16/2024] [Accepted: 08/23/2024] [Indexed: 09/30/2024]
Abstract
Infectious diseases affecting the gastrointestinal tract often present diagnostic challenges due to the variability in clinical manifestations and overlapping symptoms. Ultrasound imaging has emerged as a valuable tool in the assessment of gastrointestinal pathologies, offering non-invasive and real-time visualization of anatomical structures. This review aims to explore the role of ultrasound in the diagnosis and management of infectious diseases involving the gastrointestinal tract. We discuss the imaging features of various infectious etiologies, such as bacterial, viral, and parasitic infections, highlighting characteristic findings on ultrasound scans. Additionally, we provide insights into the utility of ultrasound for the assessment of treatment response. Through a comprehensive analysis of existing literature and clinical case studies, this review underscores the significance of ultrasound imaging as a frontline modality in the diagnosis and management of infectious diseases affecting the gastrointestinal tract.
Collapse
Affiliation(s)
- Francesca Aprile
- Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.A.); (M.V.)
| | - Marcello Vangeli
- Department of Hepatology and Gastroenterology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162 Milan, Italy; (F.A.); (M.V.)
| | - Mariangela Allocca
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
| | - Alessandra Zilli
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
| | - Marjorie Costa Argollo
- Gastroenterology Department, Federal University of São Paulo, São Paulo 04021-001, Brazil;
| | - Ferdinando D’amico
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
| | - Tommaso Lorenzo Parigi
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Silvio Danese
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
- Faculty of Medicine, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Federica Furfaro
- Department of Gastroenterology and Endoscopy, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132 Milan, Italy; (M.A.); (A.Z.); (T.L.P.); (S.D.); (F.F.)
| |
Collapse
|
|
9
|
Parra-Izquierdo V, Flórez Sarmiento C, Frías-Ordoñez JS, Vargas M, Kock J, Lozano Escobar N, Márquez JR. Clinical and therapeutic characterisation of a multicentre cohort of patients with inflammatory bowel disease in Colombia. GASTROENTEROLOGIA Y HEPATOLOGIA 2023; 46:585-593. [PMID: 36464080 DOI: 10.1016/j.gastrohep.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 11/09/2022] [Accepted: 11/24/2022] [Indexed: 12/05/2022]
Abstract
INTRODUCTION In Latin America and Colombia there are few studies about the clinical and therapeutic characteristics of patients with inflammatory bowel disease (IBD). The objective of this study is to obtain an approximation to these data from a sample of patients from different reference centres in Colombia. PATIENTS AND METHODS Cross-sectional study in adult and paediatric patients, with IBD, attended ambulatory in 6 institutions in different cities, between 2017 and 2020 information was collected on different dates, about demographic, clinical, and therapeutic aspects. RESULTS Six hundred and five subjects, 565 (93.4%) adults, mean age 43 years (SD 12.78), 64% with ulcerative colitis (UC). The age at diagnosis of UC was 41.9 years, while in Crohn's disease (CD) it was 47.9 years. In UC, there was greater left involvement (47.2%), and in CD, 42.8% ileocolonic (L3). More than 50% were in mild activity or clinical remission. In UC, the biologic requirement was 27.2%, while in CD, 78%. Overall hospitalisation requirement was 39.5%, and the need for surgery was 37.5% in UC and 62.5% in CD. Also, 40 pediatric patients, 90% female, with UC being more frequent (80%). In UC, 83.3% presented extensive colitis, and in CD, all with ileocolonic localization (L3). More than 95% were in mild activity or remission. Biologic therapy was required in 16.6% and 75% for UC and CD, respectively. The frequency of hospitalisations and surgery was 2.7%. CONCLUSIONS This study shows some unique characteristics of patients with IBD in Colombia. An earlier diagnosis is required, with a better therapeutic approach.
Collapse
Affiliation(s)
- Viviana Parra-Izquierdo
- Gastroenterología y Reumatología, Hospital Internacional de Colombia, Bucaramanga, Colombia; Grupo de Inmunología Celular y Molecular (INMUBO), Universidad del Bosque, Bogotá, Colombia; Gastroenterología y endoscopia digestiva. Gastroadvanced IPS, Bogotá, Colombia
| | - Cristian Flórez Sarmiento
- Gastroenterología y Reumatología, Hospital Internacional de Colombia, Bucaramanga, Colombia; Grupo de Inmunología Celular y Molecular (INMUBO), Universidad del Bosque, Bogotá, Colombia; Gastroenterología y endoscopia digestiva. Gastroadvanced IPS, Bogotá, Colombia
| | | | - Melquicedec Vargas
- Gastroenterología pediátrica. Clínica GastroKids S.A.S , Pereira, Risaralda, Colombia
| | - Joshua Kock
- Epidemiología, Universidad de La Sabana, Chía, Cundinamarca, Colombia
| | - Natalia Lozano Escobar
- Grupo de Inmunología Celular y Molecular (INMUBO), Universidad del Bosque, Bogotá, Colombia
| | - Juan Ricardo Márquez
- Coloproctología, Instituto de Coloproctología ICO, Clínica Las Américas, Medellín, Colombia
| |
Collapse
|
|
10
|
Brodersen JB, Jensen MD, Juel MA, Kjeldsen J, Knudsen T, Rafaelsen SR. Intestinal ultrasound in patients with suspected Crohn's disease - results of a prospective evaluation by trainees. Scand J Gastroenterol 2023; 58:1405-1411. [PMID: 37459054 DOI: 10.1080/00365521.2023.2234538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/05/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND AND AIMS Intestinal ultrasound (IUS) performed by experts is a valuable tool for the diagnostic work-up and monitoring of Crohn's disease (CD). However, concern about insufficient training and perceived high inter-observer variability limit the adoption of IUS in CD. We examined the diagnostic accuracy of trainee-performed IUS in patients with suspected CD. METHOD Patients recruited to a prospective trial investigating the diagnostic accuracy of magnetic resonance enterocolonography (MREC) in patients with clinically suspected CD underwent IUS performed by trainees. The primary end-point was IUS per-patient sensitivity and specificity for ileocolonic CD determined by ileocolonoscopy. RESULTS 129 patients with clinically suspected CD and a complete IC and IUS were included in the analysis. IUS detected signs of CD in 49 cases (small bowel 31, colon 15, small bowel, and colon 3). The sensitivity and specificity for detection of ileocolonic CD by trainee performed IUS improved during the first to the second half of the study period from 57.1% (CI 34.0-78.2) to 73.1% (CI 52.2-88.4) and 76.5% (CI 58.8-89.3) to 89.7% (CI 72.6-97.8). The overall sensitivity and specificity of diagnosing CD with IUS were 65.4% (CI 50.9-78.0) and 80.5% (CI 69.9-88.7). There was no difference in diagnostic performance between IUS and MREC for the detection of CD. CONCLUSION Trainees improved during the study, and IUS performance in disease detection corresponded to expert-evaluated MREC.Registered at ClinicalTrials.gov (NCT03134586).
Collapse
Affiliation(s)
- Jacob Broder Brodersen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Michael Dam Jensen
- Department of Regional Health Research, University of Southern Denmark, Denmark
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Mie Agerbæk Juel
- Department of Internal Medicine, Section of Gastroenterology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| | - Jens Kjeldsen
- Department of Medical Gastroenterology, Odense University Hospital, Odense, Denmark
- Research Unit of Medical Gastroenterology, Department of Clinical Research, University of Southern, Denmark
- OPEN Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
| | - Torben Knudsen
- Department of Internal Medicine, Section of Gastroenterology, Esbjerg Hospital - University Hospital of Southern Denmark, Esbjerg, Denmark
- Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Søren Rafael Rafaelsen
- Department of Regional Health Research, University of Southern Denmark, Denmark
- Department of Radiology, Lillebaelt Hospital - University Hospital of Southern Denmark, Vejle, Denmark
| |
Collapse
|
|
11
|
Xia Q, Li M, Xu M, Chen S, Xie X, Chen Y. Measurement of the stiffness of the normal terminal ileum mesentery using shear-wave elastography. Eur J Radiol 2023; 163:110807. [PMID: 37030100 DOI: 10.1016/j.ejrad.2023.110807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 03/31/2023]
Abstract
OBJECTIVE To investigate the feasibility of using shear-wave elastography (SWE) to measure the stiffness of the normal terminal ileum mesentery, and to establish its normal reference range. METHODS Ninety-five normal subjects and 22 patients with mesentery-related disease were included. The average Young's modulus of the normal terminal ileal mesentery was measured by SWE ultrasound. The thickness and the extent to which mesenteric fat extended around the intestinal circumference of the normal terminal ileum were also recorded. The normal reference range was established and the SWE values of normal and diseased subjects were compared. RESULTS Transabdominal SWE examination of the terminal ileum mesentery was successfully performed on 91 subjects (95.8 %). The mean extent range, thickness, and SWE value of the normal terminal ileum mesentery were 1/4 (1/5-1/3), 6.8 ± 2.4 mm, and 4.3 ± 2.1 kPa, respectively. These parameters did not differ significantly between genders, and across age and body mass index groups (all P > 0.05). The intra- and inter-operator consistencies were excellent for the replicated SWE measurements (0.801 [95 % confidence interval: 0.560-0.916] and 0.751 (95 % confidence interval: 0.388-0.900], respectively). The mean mesenteric elasticity in diseased subjects was 21.9 ± 10.7 kPa, which was significantly higher than that in normal subjects (P < 0.001). The cut-off value for mesenteric elasticity was 9.3 kPa, with a sensitivity of 90 % and a specificity of 100 % (P < 0.001). CONCLUSION SWE can be used to reliably evaluate the stiffness of the terminal ileum mesentery in normal subjects.
Collapse
Affiliation(s)
- Qingqing Xia
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Manying Li
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shuling Chen
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yujun Chen
- Department of Medical Ultrasonics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| |
Collapse
|
|
12
|
Bohra A, Van Langenberg DR, Vasudevan A. Intestinal Ultrasound in the Assessment of Luminal Crohn’s Disease. GASTROINTESTINAL DISORDERS 2022; 4:249-262. [DOI: 10.3390/gidisord4040024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Crohn’s disease is a chronic inflammatory disease affecting the gastrointestinal tract. Expert guidelines now recommend regular objective assessments as part of a treat-to-target approach. Intestinal ultrasound provides a noninvasive, patient-friendly modality for assessing Crohn’s disease without the risk of radiation exposure and does not require fasting or bowel preparation. Enhancement techniques, including oral and intravenous contrast, can improve disease-activity and complication detection. Due to its acceptability, intestinal ultrasound can be performed frequently, allowing for closer disease-activity monitoring and treatment adjustments. There have been significant advances in the utility of intestinal ultrasound; particularly for assessing disease activity during pregnancy and fibrosis detection utilising elastography. This review provides a comprehensive overview of performing intestinal ultrasound, the diagnostic accuracy, role in disease-activity monitoring, and recent advances in utilising ultrasound for the assessment of luminal Crohn’s disease.
Collapse
|
|
13
|
Yamada K, Ishikawa T, Kawashima H, Ohno E, Iida T, Ishikawa E, Mizutani Y, Sawada T, Maeda K, Yamamura T, Kakushima N, Furukawa K, Nakamura M, Ishigami M, Fujishiro M. Evaluation of ulcerative colitis activity using transabdominal ultrasound shear wave elastography. Quant Imaging Med Surg 2022; 12:618-626. [PMID: 34993106 DOI: 10.21037/qims-21-403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Transabdominal ultrasound (US) has been reported to be effective in the evaluation of ulcerative colitis (UC). US can measure shear wave elastography (SWE) and shear wave dispersion (SWD), which may be correlated with inflammation and necrosis. We aimed to investigate the relationship between UC activity and SWE and SWD. METHODS Patients with UC who underwent US within 2 days before or after a colonoscopy between April 2019 and March 2020 were included. SWE and SWD were measured in the sigmoid colon; the correlations of SWE and SWD with the Lichtiger index and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) were investigated. We also compared SWE and SWD between patients with mucosal healing and those in the active phase according to the UCEIS. RESULTS Twenty-six UC patients were enrolled. The median Lichtiger index, UCEIS, SWE values, and SWD values were 8 [interquartile range (IQR), 5.3-10.8], 4 (IQR, 3.3-5), 1.69 (IQR, 1.49-2.16) m/s, and 11.9 (IQR, 10.9-13.3) (m/s)/kHz, respectively. The Lichtiger index and UCEIS were negatively correlated with the SWE values (rs=-0.404 and rs=-0.506) but not with the SWD values (rs=0.004 and rs=0.002). The SWE values differed significantly between the mucosal healing and active phase groups [2.40 (IQR, 2.18-3.38) vs. 1.62 (IQR, 1.44-1.95) m/s, P=0.007], whereas the SWD values did not [13.1 (IQR, 7.05-21.6) vs. 11.9 (IQR, 11.1-13.2) (m/s)/kHz, P=0.918]. CONCLUSIONS SWE may be useful for the evaluation of UC activity and could be a noninvasive method of assessing disease severity.
Collapse
Affiliation(s)
- Kenta Yamada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kawashima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eizaburo Ohno
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tadashi Iida
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuyuki Mizutani
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsunaki Sawada
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Keiko Maeda
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Yamamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naomi Kakushima
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masatoshi Ishigami
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| |
Collapse
|
|
14
|
Maconi G, Hausken T, Dietrich CF, Pallotta N, Sporea I, Nurnberg D, Dirks K, Romanini L, Serra C, Braden B, Sparchez Z, Gilja OH. Gastrointestinal Ultrasound in Functional Disorders of the Gastrointestinal Tract - EFSUMB Consensus Statement. Ultrasound Int Open 2021; 7:E14-E24. [PMID: 34104853 PMCID: PMC8163523 DOI: 10.1055/a-1474-8013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 04/01/2021] [Indexed: 12/19/2022] Open
Abstract
Abdominal ultrasonography and intestinal ultrasonography are widely used as first diagnostic tools for investigating patients with abdominal symptoms, mainly for excluding organic diseases. However, gastrointestinal ultrasound (GIUS), as a real-time diagnostic imaging method, can also provide information on motility, flow, perfusion, peristalsis, and organ filling and emptying, with high temporal and spatial resolution. Thanks to its noninvasiveness and high repeatability, GIUS can investigate functional gastrointestinal processes and functional gastrointestinal diseases (FGID) by studying their behavior over time and their response to therapy and providing insight into their pathophysiologic mechanisms. The European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) has established a Task Force Group consisting of GIUS experts, which developed clinical recommendations and guidelines on the role of GIUS in several acute and chronic gastrointestinal diseases. This review is dedicated to the role of GIUS in assisting the diagnosis of FGID and particularly in investigating patients with symptoms of functional disorders, such as dysphagia, reflux disorders, dyspepsia, abdominal pain, bloating, and altered bowel habits. The available scientific evidence of GIUS in detecting, assessing, and investigating FGID are reported here, while highlighting sonographic findings and its usefulness in a clinical setting, defining the actual and potential role of GIUS in the management of patients, and providing information regarding future applications and research.
Collapse
Affiliation(s)
- Giovanni Maconi
- Gastroenterology Unit, Department of Biomedical and Clinical Sciences, "L.Sacco" University Hospital, Milano, Italy
| | - Trygve Hausken
- Department of Medicine, University of Bergen, Bergen, Norway
| | - Christoph F Dietrich
- Department Allgemeine Innere Medizin, Kliniken Hirslanden Beau-Site, Salem und Permanence, Bern, Switzerland
| | - Nadia Pallotta
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Roma, Italy
| | - Ioan Sporea
- Department of Gastroenterology, University of Medicine and Pharmacy, Victor Babes Timisoara, Timisoara, Romania.,Department of Gastroenterology, Universitatea de Vest din Timisoara, Timisoara, Romania
| | - Dieter Nurnberg
- Brandenburg Institute for Clinical Ultrasound (BICUS) - Medical University Brandenburg "Theodor Fontane", Faculty of Medicine and Philosophy and Faculty of Health Sciences Brandenburg, Neuruppin, Germany
| | - Klaus Dirks
- Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Laura Romanini
- Department of Radiology, Radiologia 1, Hospital of Cremona, Cremona, Italy
| | - Carla Serra
- Internal Medicine and Gastroenterology, University of Bologna, Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Zeno Sparchez
- 3rd Medical Department, University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Odd Helge Gilja
- Haukeland University Hospital, Haukeland University Hospital, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
|
15
|
Allocca M, Furfaro F, Fiorino G, Peyrin-Biroulet L, Danese S. Point-of-Care Ultrasound in Inflammatory Bowel Disease. J Crohns Colitis 2021; 15:143-151. [PMID: 32674146 DOI: 10.1093/ecco-jcc/jjaa151] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Inflammatory bowel diseases [IBD], including Crohn's disease [CD] and ulcerative colitis [UC], are chronic, relapsing and destructive inflammatory disorders of the gastrointestinal tract which can lead to organ damage and impair quality of life. A 'treat-to-target' strategy based on activity and severity of disease and response to treatment with close monitoring of intestinal inflammation is recommended. Ileocolonoscopy [CS] is considered the first-line procedure for the assessment of IBD, and magnetic resonance enterography [MRE] is the current standard for assessing the small bowel and complications in CD, and has been proposed as an alternative procedure to CS in the evaluation of both ileo-colonic CD and UC. As that both CS and MRE are invasive and expensive procedures and unappealing to patients, they are unfeasible as frequent and repetitive tools for the monitoring of disease activity. Bowel ultrasound [US] represents a well-tolerated, non-invasive and cost-effective modality to manage IBD patients in clinical practice. Compared to CS and MRE, bowel US has been shown to have the same level of accuracy in assessing and monitoring disease activity and severity of both CD and UC. It can be performed at the point-of-care and therefore allow for real-time clinical decision-making. Point-of-care ultrasound [POCUS] is suggested as the stethoscope of the future and is gaining interest and diffusion in the medical field because it can be used for the bedside examination of patients. The aim of this review is to discuss point-of-care bowel ultrasound [POCBUS] in the management of patients with IBD.
Collapse
Affiliation(s)
- Mariangela Allocca
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy
| | - Gionata Fiorino
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| | - Laurent Peyrin-Biroulet
- Department of Gastroenterology and Inserm U954, University Hospital of Nancy, Lorraine University, Nancy, France
| | - Silvio Danese
- Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, Rozzano (Mi), Italy.,Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, Pieve Emanuele - Milan, Italy
| |
Collapse
|
|
16
|
Muñoz F, Ripollés T, Poza Cordón J, de Las Heras Páez de la Cadena B, Martínez-Pérez MJ, de Miguel E, Zabana Y, Mañosa Ciria M, Beltrán B, Barreiro-de Acosta M. Recommendations of the Spanish Working Group on Crohn's Disease and Ulcerative Colitis (GETECCU) on the use of abdominal ultrasound in inflammatory bowel disease. GASTROENTEROLOGIA Y HEPATOLOGIA 2020; 44:158-174. [PMID: 33309386 DOI: 10.1016/j.gastrohep.2020.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 10/22/2022]
Abstract
Ultrasound has an excellent diagnostic performance when Crohn's disease is suspected, when performing an activity assessment, or determining the extension and location of Crohn's disease, very similar to other examinations such as MRI or CT. It has a good correlation with endoscopic lesions and allows the detection of complications such as strictures, fistulas or abscesses. It complements colonoscopy in the diagnosis and, given its tolerance, cost and immediacy, it can be considered as a good tool for disease monitoring. In ulcerative colitis, its role is less relevant, being limited to assessing the extent and activity when it is not possible with other diagnostic techniques or if there are doubts with these. Despite its advantages, its use in inflammatory bowel disease (IBD) is not widespread in Spain. For this reason, this document reviews the advantages and disadvantages of the technique to promote knowledge about it and implementation of it in IBD Units.
Collapse
Affiliation(s)
- Fernando Muñoz
- Servicio de Digestivo. Complejo Asistencial Universitario de Salamanca, España.
| | - Tomás Ripollés
- Servicio Radiodiagnóstico, Hospital Universitario Dr. Peset, Valencia, España
| | - Joaquín Poza Cordón
- Servicio de Aparato Digestivo del Hospital Universitario La Paz, Madrid, España
| | | | | | - Enrique de Miguel
- Servicio de Radiodiagnóstico, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Yamile Zabana
- Servicio de Gastroenterología, Unidad de Enfermedad Inflamatoria Intestinal, Hospital Universitari Mútua de Terrassa, CIBERehd, Barcelona, España
| | - Miriam Mañosa Ciria
- Unidad de EII. Servei d'Aparell digestiu. Hospital Universitari Germans Trias i Pujol, CIBERehd, Barcelona, España
| | - Belén Beltrán
- Servicio de Medicina Digestiva, Hospital Universitario La Fe, CIBERehd, Valencia, España
| | - Manuel Barreiro-de Acosta
- Unidad EII. Servicio de Aparato Digestivo. Hospital Clínico Universitario de Santiago, A Coruña, España
| |
Collapse
|
|
17
|
|
|
18
|
Martínez Pérez MJ, Blanc García E, Merino Bonilla JA. Bowel ultrasound: examination techniques and normal and pathologic patterns. RADIOLOGIA 2020; 62:517-527. [PMID: 33127091 DOI: 10.1016/j.rx.2020.09.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/31/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Ultrasound is being increasingly used to study the digestive tract because it has certain advantages over other techniques such as endoscopy, CT enterography, and MR enterography. Ultrasound can be used to evaluate the bowel wall and the elements that surround it without the need for contrast agents; its ability to evaluate the elasticity and peristalsis of these structures is increasing interest in its use. This article describes the techniques and modalities of bowel ultrasound, as well as the normal features of the bowel wall and contiguous structures. It uses a practical approach to review the main pathological findings and their interpretation, and the different patterns of presentation, which will help orient the diagnosis.
Collapse
Affiliation(s)
- M J Martínez Pérez
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España.
| | - E Blanc García
- Servicio de Radiodiagnóstico, Hospital Universitario Doctor Peset, Valencia, España
| | - J A Merino Bonilla
- Servicio de Radiodiagnóstico, Hospital Santiago Apóstol, Miranda de Ebro, Burgos, España
| |
Collapse
|
|
19
|
Kakkadasam Ramaswamy P, Vizhi N K, Yelsangikar A, Krishnamurthy AN, Bhat V, Bhat N. Utility of bowel ultrasound in assessing disease activity in Crohn's disease. Indian J Gastroenterol 2020; 39:495-502. [PMID: 33201441 DOI: 10.1007/s12664-020-01019-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/04/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrointestinal ultrasound (GIUS) has been used increasingly for monitoring inflammatory bowel disease (IBD) patients. The aim of this study was to assess the utility of GIUS in assessing disease activity in Crohn's disease (CD). METHODS Consecutive patients with CD (diagnosis established for at least 6 months) between July 2017 and July 2018 requiring assessment of disease activity were prospectively assessed by magnetic resonance enterography, colonoscopy (CS), and GIUS within a 2-week period and without any change in ongoing treatment. Features on GIUS which correlated with disease activity were assessed. Sensitivity and specificity of the GIUS in assessing disease activity and localization were calculated. RESULTS Thirty-five patients were enrolled in the study. Bowel wall thickness (BWT) ≥ 3 mm and Doppler activity ≥ 2 had the highest sensitivity (100% and 95.6%, respectively) for detecting active disease on CS. BWT ≥ 3 mm had sensitivity, specificity, positive predictive value, and negative predictive value of 100%, 83.3%, 92%, and 100%, respectively for assessing active disease. Combination of median BWT, Doppler activity, and loss of bowel wall stratification correlated with simplified endoscopic score (SES) for CD (r = 0.8, p 0.009) and Harvey-Bradshaw index (HBI, r = 0.76, p 0.04). For localizing active disease in the ileum, GIUS had a sensitivity of 93.7%, 80% for lesions in the right colon, 100% for transverse colon, and 89% for the left colon. Specificity was 100% for ileal and colonic lesions. CONCLUSION Loss of stratification, BWT, and Doppler activity in the bowel wall correlate with endoscopic and clinical disease activity in CD. GIUS is a sensitive modality in assessing disease activity in CD.
Collapse
Affiliation(s)
- Pradeep Kakkadasam Ramaswamy
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India.
| | - Kayal Vizhi N
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India
| | - Amit Yelsangikar
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India
| | - Anupama Nagar Krishnamurthy
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India
| | - Vinay Bhat
- Department of Surgery and Allied Sciences, Aster CMI Hospital, Bangalore 560 092, India
| | - Naresh Bhat
- Department of Gastroenterology, Liver Diseases and Clinical Nutrition, Aster CMI Hospital, #43/2, International Airport Road, Sahakar Nagar, Bangalore, 560 092, India
| |
Collapse
|
|
20
|
Klinger C, Riecken B, Dietrich CF, Dirks K, Caca K, Fröhlich E. Use of Ultrasound in the Diagnostic Work-Up of Adult Intussusception - A Multicenter Retrospective Analysis. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2020; 41:418-427. [PMID: 29975971 DOI: 10.1055/a-0604-2676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE To evaluate the use of ultrasound (US) in the diagnostic work-up of adult intussusception (AI). METHODS This multicenter study includes 26 consecutive patients diagnosed with AI between January 2010 and November 2017. A retrospective chart analysis was conducted with a focus on abdominal US findings and diagnostic accuracy of different imaging modalities (ultrasound, computed tomography (CT), magnetic resonance imaging). If available, surgical and pathological findings served as the gold standard (76.9 %). US examiners certified according to DEGUM grade 2 or 3 were classified as experts. Otherwise, they were regarded to have basic skills. RESULTS During diagnostic work-up, 92.3 % underwent abdominal US. US was the first-line imaging modality in 88.5 % of cases. The accuracy regarding the detection of AI (85 %), correct localization (95 %) and detection of complications (100 %) was excellent and comparable with CT (81 %, 90.5 %, and 91.7 %) when performed by experts. 72.7 % of tumorous lead points were detected by experienced examiners. In contrast, AI was detected in only 45.5 % of cases by examiners with basic skills. AI was diagnosed prior to surgery in all patients. CONCLUSION US is reliable in the diagnostic work-up of AI when performed by experienced examiners with high-quality equipment. US, CT and MRI should be used in a complementary fashion since combination provides excellent sensitivity regarding the detection and correct localization of AI as well as the detection of complications. The impact of real-time imaging is illustrated by supplementary videos.
Collapse
Affiliation(s)
- Christoph Klinger
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Germany
| | - Bettina Riecken
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Germany
| | - Christoph Frank Dietrich
- Department of Internal Medicine 2, Caritas-Krankenhaus Bad Mergentheim gGmbH, Bad Mergentheim, Germany
| | - Klaus Dirks
- Gastroenterology and Internal Medicine, Rems-Murr-Klinikum Winnenden, Germany
| | - Karel Caca
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Germany
| | - Eckhart Fröhlich
- Internal Medicine I, University hospital Tuebingen, Tübingen, Germany
| |
Collapse
|
|
21
|
Pistoia M, Perrone T, Fiengo A, Lenti MV, Di Sabatino A. Utility of intestinal ultrasound in the diagnosis and short-term follow-up of non-steroidal anti-inflammatory drug-induced enteropathy. Intern Emerg Med 2020; 15:729-731. [PMID: 31372824 DOI: 10.1007/s11739-019-02161-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/24/2019] [Indexed: 02/02/2023]
Affiliation(s)
- Matteo Pistoia
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
- Medicina Generale 1, Fondazione IRCCS Policlinico San Matteo, Università Degli Studi Di Pavia, Viale Golgi 19, 27100, Pavia, Italy.
| | - Tiziano Perrone
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Anna Fiengo
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Antonio Di Sabatino
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| |
Collapse
|
|
22
|
Ong AML. Utility of gastrointestinal ultrasound in functional gastrointestinal disorders: A narrative review. World J Meta-Anal 2020; 8:109-118. [DOI: 10.13105/wjma.v8.i2.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/05/2020] [Accepted: 03/09/2020] [Indexed: 02/05/2023] Open
Abstract
Gastrointestinal (GI) ultrasound (GIUS) is valuable in the evaluation of GI diseases such as inflammatory bowel disease, but its use in functional GI disorders (FGIDs) is largely unknown although promising. In order to review the current knowledge on current and potential uses of GIUS in FGIDs, information was obtained via a structured literature search through PubMed, EMBASE and Google Scholar databases with a combination of MESH and keyword search terms: “ultrasound”, “functional GI disorders”, “irritable bowel syndrome”, “functional dyspepsia”, “intestinal ultrasound”, “point of care ultrasonography”, “transabdominal sonography”, “motility”, “faecal loading”, “constipation”. GIUS is currently used for various settings involving upper and lower GI tracts, including excluding organic diseases, evaluating physiology, guiding treatment options and building rapport with patients. GIUS can be potentially used to correlate mechanisms with symptoms, evaluate mechanisms behind treatment efficacy, and investigate further the origin of symptoms in real-time. In conclusion, GIUS is unique in its real-time, interactive and non-invasive nature, with the ability of evaluating several physiological mechanisms with one test, thus making it attractive in the evaluation and management of FGIDs. However, there are still limitations and concerns of operator dependence and lack of validation data for widespread implementation of GIUS in FGIDs.
Collapse
Affiliation(s)
- Andrew Ming-Liang Ong
- Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore 169856, Singapore
- Duke-NUS Medical School, Singapore 169857, Singapore
| |
Collapse
|
|
23
|
Costantino A, Giunta M, Casazza G, Arona S, Colli A, Conte D, Vecchi M, Fraquelli M. Is pocket-size ultrasound a reliable tool for bowel investigation? A study on its feasibility, reproducibility and diagnostic accuracy. Dig Liver Dis 2020; 52:38-43. [PMID: 31409578 DOI: 10.1016/j.dld.2019.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/26/2019] [Accepted: 07/12/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intestinal ultrasound (IUS) examination is a first-line non-invasive imaging procedure for patients with suspicion of bowel diseases. AIM To assess the feasibility, reproducibility and diagnostic accuracy of a pocket-size ultrasound device (PUD) in identifying the presence of intestinal alterations in patients consecutively recruited to undergo IUS examination. METHODS 200 consecutive patients (57% female, 48.8 years) underwent both PUD (two independent investigators) and IUS examination on the same day. Nine ultrasonographic signs were systematically searched for. PUD inter-observer reproducibility was assessed by kappa statistic and ICC. The diagnostic accuracy of PUD as compared to IUS results was assessed by calculating sensitivity, specificity and corresponding positive and negative likelihood ratios. RESULTS PUD and IUS examinations were successful in 100% of the patients. PUD reproducibility was good/excellent at evidencing the presence (ICC 0.84) and length (ICC 0.85) of an intestinal tract with thickened wall and abdominal free fluid (ICC 0.87). The diagnostic accuracy of PUD, compared to traditional IUS, was good with regard to the presence of bowel wall thickening (sensitivity 92%, specificity 95%), the length of the thickened bowel (sensitivity 94%, specificity 95%) and the presence of free fluid (sensitivity 81%, specificity 99%). CONCLUSIONS PUD is a feasible, reproducible and accurate first-line screening tool for the assessment of the gastro-intestinal tract.
Collapse
Affiliation(s)
- Andrea Costantino
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | | | - Giovanni Casazza
- Dipartimento di Scienze Biomediche e Cliniche, Ospedale "L. Sacco", Università degli Studi di Milano, Milan, Italy
| | - Silvia Arona
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Agostino Colli
- Dipartimento di Medicina Interna, Ospedale "A. Manzoni", Lecco, Italy
| | - Dario Conte
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy
| | - Mirella Fraquelli
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Università di Milano, Milan, Italy.
| |
Collapse
|
|
24
|
Bezzio C, Saibeni S. Gastrointestinal ultrasound in inflammatory bowel disease: Seeing beyond limits. Dig Liver Dis 2020; 52:19-20. [PMID: 31786084 DOI: 10.1016/j.dld.2019.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Cristina Bezzio
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy
| | - Simone Saibeni
- Gastroenterology Unit, Rho Hospital, ASST Rhodense, Rho, Italy.
| |
Collapse
|
|
25
|
Paredes JM, Moreno N, Latorre P, Ripollés T, Martinez MJ, Vizuete J, Moreno-Osset E. Clinical Impact of Sonographic Transmural Healing After Anti-TNF Antibody Treatment in Patients with Crohn's Disease. Dig Dis Sci 2019; 64:2600-2606. [PMID: 30874986 DOI: 10.1007/s10620-019-05567-w] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 02/26/2019] [Indexed: 12/13/2022]
Abstract
AIM To assess the clinical benefits of transmural healing (TH) shown on intestinal ultrasound (IUS) after treatment with tumor necrosis factor-alpha antibodies (anti-TNF) in patients with Crohn's disease. MATERIALS AND METHODS This prospective study included consecutively 36 patients who underwent IUS in the week prior to start anti-TNF treatment, at 12 weeks, and 1 year after starting treatment. The clinical response to treatment was assessed using the Crohn's disease activity index and C-reactive protein (CRP) values. TH was defined as the normalization of bowel wall thickness on IUS. Treated patients were considered to have a good outcome if none of the following situations presented: need to reintroduce corticosteroids or intensify maintenance therapy and/or need for surgery. RESULTS After the induction regimen, 29 patients (80.6%) achieved clinical remission, and serum CRP values returned to normal in 20 patients (55.6%). In the IUS at 12 weeks, treatment induced a statistically significant reduction in the wall thickness (p < 0.001) and color Doppler grade (p < 0.001), as well as resolution of complications in 66.7% of patients (p < 0.03). IUS after 1 year of biological therapy showed TH in 14/33 patients (42.4%). During the follow-up (median 48.5 months), 23 of the 33 (69.7%) patients in remission or response after induction therapy presented a good outcome. Sonographic TH was significantly related with better outcomes, with only 1/14 patients having a poor outcome compared to 9/19 without TH (OR 11.7, 95% CI 1.2-108.2 p = 0.01, Chi-squared test). CONCLUSION Patients who achieve TH on IUS with biological treatment have better clinical outcomes.
Collapse
Affiliation(s)
- José María Paredes
- Department of Digestive Medicine, Hospital Universitario Dr. Peset, University of Valencia, Gaspar Aguilar 90, 46017, Valencia, Spain.
| | - Nadia Moreno
- Department of Digestive Medicine, Hospital Universitario Dr. Peset, University of Valencia, Gaspar Aguilar 90, 46017, Valencia, Spain
| | - Patricia Latorre
- Department of Digestive Medicine, Hospital Universitario Dr. Peset, University of Valencia, Gaspar Aguilar 90, 46017, Valencia, Spain
| | - Tomás Ripollés
- Department of Diagnostic Radiology, Hospital Universitario Dr. Peset, Gaspar Aguilar 90, 46017, Valencia, Spain
| | - María Jesús Martinez
- Department of Diagnostic Radiology, Hospital Universitario Dr. Peset, Gaspar Aguilar 90, 46017, Valencia, Spain
| | - José Vizuete
- Department of Diagnostic Radiology, Hospital Universitario Dr. Peset, Gaspar Aguilar 90, 46017, Valencia, Spain
| | - Eduardo Moreno-Osset
- Department of Digestive Medicine, Hospital Universitario Dr. Peset, University of Valencia, Gaspar Aguilar 90, 46017, Valencia, Spain
| |
Collapse
|
|
26
|
Abstract
Ultrasound (US) is an important imaging tool and the most commonly used imaging modality worldwide. Although US requires expertise to be performed at the highest quality levels, basic US exams can be learned by most physicians and medical technologists with knowledge of human anatomy and with physical examination skills. The full potential of US is achieved when it is more than a pure “imaging modality”, but instead an integrated clinical, physical, and imaging assessment in which the examiner interacts directly and personally with the patient. Specific diagnostic US knowledge is strongly encouraged for specialist training in clinical disciplines.
Collapse
|
|
27
|
Dietrich CF, Arcidiacono PG, Braden B, Burmeister S, Carrara S, Cui X, Di Leo M, Dong Y, Fusaroli P, Gilja OH, Healey AJ, Hocke M, Hollerbach S, Garcia JI, Ignee A, Jürgensen C, Kahaleh M, Kitano M, Kunda R, Larghi A, Möller K, Napoleon B, Oppong KW, Petrone MC, Saftoiu A, Puri R, Sahai AV, Santo E, Sharma M, Soweid A, Sun S, Teoh AYB, Vilmann P, Jenssen C. What should be known prior to performing EUS? Endosc Ultrasound 2019; 8:3-16. [PMID: 30777940 PMCID: PMC6400085 DOI: 10.4103/eus.eus_54_18] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Direct referral of patients for EUS – instead of preprocedural consultation with the endosonographer – has become standard practice (like for other endoscopic procedures) as it is time- and cost-effective. To ensure appropriate indications and safe examinations, the endosonographer should carefully consider what information is needed before accepting the referral. This includes important clinical data regarding relevant comorbidities, the fitness of the patient to consent and undergo the procedure, and the anticoagulation status. In addition, relevant findings from other imaging methods to clarify the clinical question may be necessary. Appropriate knowledge and management of the patients’ anticoagulation and antiplatelet therapy, antibiotic prophylaxis, and sedation issues can avoid unnecessary delays and unsafe procedures. Insisting on optimal preparation, appropriate indications, and clear clinical referral questions will increase the quality of the outcomes of EUS. In this paper, important practical issues regarding EUS preparations are raised and discussed from different points of view.
Collapse
Affiliation(s)
- Christoph F Dietrich
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany; Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Paolo Giorgio Arcidiacono
- Pancreatico/Biliary Endoscopy & Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Barbara Braden
- Translational Gastroenterology Unit I John Radcliffe Hospital I Oxford OX3 9DU, UK
| | - Sean Burmeister
- Surgical Gastroenterology unit, Groote Schuur Hospital, Cape Town, South Africa
| | - Silvia Carrara
- Humanitas Clinical and Research Center- IRCCS- Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan, Italy
| | - Xinwu Cui
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Milena Di Leo
- Humanitas Clinical and Research Center- IRCCS- Digestive Endoscopy Unit, Division of Gastroenterology, Rozzano, Milan, Italy
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Pietro Fusaroli
- Department of Medical and Surgical Sciences, Gastroenterology Unit, University of Bologna/Imola Hospital, Imola, Italy
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Andrew J Healey
- General and HPB Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Michael Hocke
- Medical Department, Helios Klinikum Meiningen, Germany
| | - Stephan Hollerbach
- Department of Gastroenterology, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Julio Iglesias Garcia
- Department of Gastroenterology and Hepatology, Health Research Institute of Santiago de Compostela (IDIS), University Hospital of Santiago de Compostela, Santiago de Compostela, Spain
| | - André Ignee
- Medical Department 2, Caritas-Krankenhaus, Uhlandstr 7, D-97980 Bad Mergentheim, Germany
| | | | - Michel Kahaleh
- Department of Gastroenterology, The State University of New Jersey, New Jersey, USA
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Rastislav Kunda
- Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark; Department of Surgery and Department of Advanced Interventional Endoscopy, University Hospital Brussels, Brussels, Belgium
| | - Alberto Larghi
- Digestive Endoscopy Unit, IRCCS Foundation University Hospital, Policlinico A. Gemelli, Rome, Italy
| | - Kathleen Möller
- Medical Department I/Gastroenterology, SANA Hospital Lichtenberg, Berlin, Germany
| | - Bertrand Napoleon
- Digestive Endoscopy Unit, Hopital Privé J Mermoz Ramsay Générale de Santé, Lyon, France
| | | | - Maria Chiara Petrone
- Pancreatico/Biliary Endoscopy & Endosonography Division, Pancreas Translational & Clinical Research Center, San Raffaele Scientific Institute, Vita Salute San Raffaele University, Milan, Italy
| | - Adrian Saftoiu
- Department of Gastroenterology, Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Rajesh Puri
- Interventional Gastroenterology, Institute of Digestive and Hepatobiliary Sciences Medanta the Medicity, Gurugram, Haryana, India
| | - Anand V Sahai
- Center Hospitalier de l'Université de Montréal, Montreal, Canada
| | - Erwin Santo
- Department of Gastroenterology and Liver Diseases, Tel Aviv, Sourasky Medical Center, Tel Aviv, Israel
| | - Malay Sharma
- Department of Gastroenterology, Jaswant Rai Speciality Hospital, Meerut, Uttar Pradesh, India
| | - Assaad Soweid
- Endosonography and advanced therapeutic endoscopy, Division of Gastroenterology, The American University of Beirut, Medical Center, Beirut, Lebanon
| | - Siyu Sun
- Endoscopy Center, ShengJing Hospital of China Medical University, Shenyang, Liaoning, China
| | - Anthony Yuen Bun Teoh
- Division of Upper Gastrointestinal and Metabolic Surgery, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Vilmann
- GastroUnit, Department of Surgery, Copenhagen University, Hospital Herlev, Denmark
| | - Christian Jenssen
- Department of Internal Medicine, Krankenhaus Maerkisch-Oderland, D-15344 Strausberg and Brandenburg Institute of Clinical Ultrasound at Medical University Brandenburg, Germany
| |
Collapse
|
|
28
|
Jenssen C, Gilja OH, Serra AL, Piscaglia F, Dietrich CF, Rudd L, Sidhu PS. European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) Policy Document Development Strategy - Clinical Practice Guidelines, Position Statements and Technological Reviews. Ultrasound Int Open 2018; 5:E2-E10. [PMID: 30599040 PMCID: PMC6251059 DOI: 10.1055/a-0770-3965] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/07/2018] [Accepted: 10/10/2018] [Indexed: 12/19/2022] Open
Abstract
This document summarizes principles and methodology to guide the creation of Clinical Practice Guidelines, Position Statements und Technological Reviews of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). The purpose of EFSUMB Clinical Practice Guidelines is to provide physicians and sonographers performing or requesting diagnostic and interventional ultrasound examinations with evidence-based recommendations. Position Statements summarize EFSUMB opinions on important current issues in clinical applications, education and training of ultrasound techniques or health care policy related to ultrasound-based imaging and ultrasound-guided interventions. The third type of EFSUMB policy document is the Technological Review, which describes ultrasound techniques and technologies for physicians, medical technicians, engineers and physicists developing ultrasound technology. The whole process of development of EFSUMB policy documents is explained beginning with the decision regarding topics, selection of authors, funding, and planning of the developmental process. Further steps described in this document are the review of the evidence, creation of recommendations, statements and comments, grading of level of evidence and strength of recommendations, and consensus process. Finally, rules for the creation, review, approval, publication and update of EFSUMB policy documents are described.
Collapse
Affiliation(s)
- Christian Jenssen
- Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen, Norway
| | - Andreas L Serra
- Klinik Hirslanden, Department of Internal Medicine and Nephrology, Zurich, Switzerland
| | - Fabio Piscaglia
- Div. Internal Medicine, Dept of Medical and Surgical Sciences, Bologna, Italy
| | | | - Lynne Rudd
- European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB) , General Secretary, London, United Kingdom of Great Britain and Northern Ireland
| | - Paul S Sidhu
- King's College London, Radiology, London, United Kingdom of Great Britain and Northern Ireland
| |
Collapse
|
|
29
|
Smereczyński A, Kołaczyk K. Pitfalls in ultrasound imaging of the stomach and the intestines. J Ultrason 2018; 18:207-211. [PMID: 30451403 PMCID: PMC6442211 DOI: 10.15557/jou.2018.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 11/22/2022] Open
Abstract
The gastrointestinal tract is an extraordinary human organ in terms of its morphology and function. Its complex structure and enormous length as well as frequent presence of gas discourage many doctors performing ultrasound examination from its exploration. Moreover, there are anatomical structures in multiple locations which can mimic certain abnormalities. It is difficult to present an exhaustive account of the problem of gastrointestinal tract ultrasound imaging errors in a single work; therefore, this study focuses mainly on false positive errors which usually result from a lack of knowledge of anatomical variants of the gastrointestinal tract structure. In the case of the stomach, rugae and muscle layer thickening towards the pylorus have been mentioned, which constitute variants of the structure of this organ examined when empty. Diagnostic pitfalls in the small intestine may include the dudenojejunal flexure (ligament of Treitz), the horizontal part of the duodenum and the ileocaecal valve. The status of the apparent lesions in all of the cases mentioned will be resolved following fluid intake by the patient. In the colon, the varied structure of semilunar folds should be taken note of. Their large thickness can warrant suspicion of wall invasion or a polyp. In addition, the study emphasises the importance of appropriate preparation of a patient for gastrointestinal tract examination since it determines the accuracy of the diagnosis. The authors also take note of common ‘sins’ of physicians such as hasty examination and failure to comply with the stomach and appendix examination protocol.
Collapse
Affiliation(s)
- Andrzej Smereczyński
- Ultrasound Self-Study Club, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Kołaczyk
- Ultrasound Self-Study Club, Department of Genetics and Pathology, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
|
30
|
Strain elastography in Crohn's disease: the role of visual observation and semiquantitative parameters. J Ultrasound 2018; 22:227-239. [PMID: 30343355 DOI: 10.1007/s40477-018-0324-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022] Open
Abstract
Strain elastography is a recently developed ultrasound method that seems to contribute to the diagnosis and monitoring of inflammatory bowel diseases. This pictorial essay aims to present the feasibility of strain elastography in clinical practice by comparing visual observation and semiquantitative parameters with endoscopic or radiological images in some common cases of Crohn's disease. In our opinion, strain elastography with visual observation is easily performed in connection with B-mode ultrasound and color Doppler imaging and may provide relevant information. Strain elastography with the elaboration of semiquantitative parameters is not as immediate as the visual observation method, but it seems to provide more objective data and seems more appropriate for monitoring the evolution of the disease. However, for the elastographic method to extensively contribute in inflammatory bowel diseases, standardization and further studies are required to confirm the promising results already reported in the literature.
Collapse
|
|
31
|
Kucharzik T, Maaser C. Intestinal ultrasound and management of small bowel Crohn's disease. Therap Adv Gastroenterol 2018; 11:1756284818771367. [PMID: 29881463 PMCID: PMC5987904 DOI: 10.1177/1756284818771367] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 03/11/2018] [Indexed: 02/04/2023] Open
Abstract
As Crohn's disease (CD) is predominantly located within the small bowel, imaging of the small bowel plays an intriguing role in the primary diagnosis as well as in the monitoring of patients with CD. Intestinal ultrasound (IUS) offers several advantages over endoscopy and other imaging modalities. Obvious advantages of IUS include noninvasiveness, rapid availability and cost effectiveness. IUS has been shown to have high accuracy in detecting small bowel CD and determining intra- and extramural complications such as stenoses, fistulae and abscesses. IUS has also been shown to be highly effective in determining postoperative disease recurrence and in follow up of patients under treatment. The following review summarizes current developments in the use of IUS for the detection of small bowel lesions and complications. The aim of this review is to suggest algorithms on how to use IUS in managing patients with small bowel CD in clinical practice. Suggested applications on the use of high frequency IUS in CD are extended by discussing new developments such as contrast-enhanced ultrasonography and elastography.
Collapse
|
|
32
|
Pinto J, Azevedo R, Pereira E, Caldeira A. Ultrasonography in Gastroenterology: The Need for Training. GE-PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2018; 25:308-316. [PMID: 30480048 DOI: 10.1159/000487156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/24/2018] [Indexed: 11/19/2022]
Abstract
The use of ultrasonography (US) as an imaging modality in medicine has spread across almost every clinical specialty. This diffusion is based on the simplicity, accessibility, portability and affordability of the technique producing real-time high-resolution images using non-ionising radiation. On the other hand, this trend also extended the technique to settings other than healthcare, such as public facilities, private houses or remote sites. This tendency can be observed worldwide, from developing countries to prestigious medical schools and tertiary referral hospitals. Furthermore, point-of-care US (POCUS), i.e., US executed at the patient's bedside to obtain real-time objective information with diagnostic and clinical monitoring purposes or to guide invasive procedures, has been incorporated in many specialties. In gastroenterology, despite the essential role of endoscopy, clinical practice is highly dependent on non-endoscopic imaging techniques. However, as in other specialties, the indications of US in gastroenterology have been increasing steadily, covering a broad range of conditions. In response to the generalised employment of US by non-radiologists, institutions such as the European Federation of Societies for Ultrasound in Medicine and Biology and the Royal College of Radiologists issued recommendations to ensure high-quality practice. These theoretical and practical requisites include performing a certain number of examinations and mandatory skills in order to achieve certification to execute unsupervised US. Therefore, there is a need for modern gastroenterology to include US as a basic skill in its clinical practice. To ensure the provision of high-quality US, adequate instruction of future specialists should be guaranteed by the gastroenterology departments and required in the residency training programme.
Collapse
Affiliation(s)
- João Pinto
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Richard Azevedo
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Eduardo Pereira
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| | - Ana Caldeira
- Gastroenterology Department, Amato Lusitano Hospital, Castelo Branco, Portugal
| |
Collapse
|
|
33
|
Dietrich CF, Averkiou M, Nielsen MB, Barr RG, Burns PN, Calliada F, Cantisani V, Choi B, Chammas MC, Clevert DA, Claudon M, Correas JM, Cui XW, Cosgrove D, D'Onofrio M, Dong Y, Eisenbrey J, Fontanilla T, Gilja OH, Ignee A, Jenssen C, Kono Y, Kudo M, Lassau N, Lyshchik A, Franca Meloni M, Moriyasu F, Nolsøe C, Piscaglia F, Radzina M, Saftoiu A, Sidhu PS, Sporea I, Schreiber-Dietrich D, Sirlin CB, Stanczak M, Weskott HP, Wilson SR, Willmann JK, Kim TK, Jang HJ, Vezeridis A, Westerway S. How to perform Contrast-Enhanced Ultrasound (CEUS). Ultrasound Int Open 2018; 4:E2-E15. [PMID: 29423461 PMCID: PMC5802984 DOI: 10.1055/s-0043-123931] [Citation(s) in RCA: 216] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 02/06/2023] Open
Abstract
"How to perform contrast-enhanced ultrasound (CEUS)" provides general advice on the use of ultrasound contrast agents (UCAs) for clinical decision-making and reviews technical parameters for optimal CEUS performance. CEUS techniques vary between centers, therefore, experts from EFSUMB, WFUMB and from the CEUS LI-RADS working group created a discussion forum to standardize the CEUS examination technique according to published evidence and best personal experience. The goal is to standardise the use and administration of UCAs to facilitate correct diagnoses and ultimately to improve the management and outcomes of patients.
Collapse
Affiliation(s)
- Christoph F. Dietrich
- Caritas-Krankenhaus, Medizinische Klinik 2, Bad Mergentheim, Germany and Ultrasound Department, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | | | | | - Richard G. Barr
- Radiology, Northeastern Ohio Medical University, Rootstown, United States
| | - Peter N. Burns
- Dept Medical Biophysics, University of Toronto. Sunnybrook Research Institute, Toronto, Canada
| | - Fabrizio Calliada
- Policlinico San Matteo, University of Pavia, Department of Radiology, Pavia, Italy
| | - Vito Cantisani
- Department of Radiology, "Sapienza" University of Rome, ROME, Italy
| | - Byung Choi
- Department of Radiology, Chung-Ang University Hosptial, Seoul, Korea (the Republic of)
| | - Maria C. Chammas
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Instituto de Radiologia, São Paulo, Brazil
| | - Dirk-André Clevert
- Department of Clinical Radiology, University of Munich-Grosshadern Campus, Munich, Germany
| | - Michel Claudon
- Department of Pediatric Radiology, Centre Hospitalier Universitaire de Nancy and Université de Lorraine, Vandoeuvre, France
| | - Jean-Michel Correas
- Hopital universitaire Necker-Enfants malades, Service de Radiologie Adultes, Paris, France
| | - Xin-Wu Cui
- Department of Medical Ultrasound, Tongji Hospital of Tongji Medical college, Huahzong University of Science and technology, Wuhan, China
| | - David Cosgrove
- Imperial College London, Imaging, London, United Kingdom of Great Britain and Northern Ireland
| | | | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
| | - JohnR. Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, United States
| | - Teresa Fontanilla
- Radiology, Hospital Universitario Puerta del Hierro Majadahonda, Majadahonda, Spain
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen and Department of Clinical Medicine, University of Bergen, Norway
| | - Andre Ignee
- Department of Medical Ultrasound, Tongji Hospital of Tongji Medical college, Huahzong University of Science and technology, Wuhan, China
| | - Christian Jenssen
- Krankenhaus Märkisch Oderland Strausberg/ Wriezen, Klinik für Innere Medizin, Wriezen, Germany
| | - Yuko Kono
- Department of Medicine and Radiology, University of California, San Diego, United States
| | - Masatoshi Kudo
- Kinki Daigaku Igakubu, Department Gastroenterology and Hepatology, Osakasayama, Osaka, Japan
| | - Nathalie Lassau
- Gustave Roussy and IR4MUMR8081. Université Paris-Sud, Université Paris-Saclay, Radiology, Paris, France
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University, Philadelphia, United States
| | - Maria Franca Meloni
- Radiology Department of Interventional Ultrasound - Casa di cura Igea- Milano, Italy
| | - Fuminori Moriyasu
- Sanno Hospital,International University of Helth and Welfare, Center for Cancer Ablation Therapy, Tokyo, Japan
| | - Christian Nolsøe
- Ultrasound Section, Division of Surgery, Dep. of Gastroenterology, Herlev Hospital Copenhagen Academy for Medical Education and Simulation (CAMES), University of Copenhagen, Denmark
| | - Fabio Piscaglia
- Div. Internal Medicine, Dept of Medical and Surgical Sciences, Bologna, Italy
| | - Maija Radzina
- P.Stradina Clinical University Hospital, Diagnosic Radiology Institute, Riga, Latvia
| | - Adrian Saftoiu
- Research Center of Gastroenterology and Hepatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Paul S. Sidhu
- King's College London, Radiology, London, United Kingdom of Great Britain and Northern Ireland
| | - Ioan Sporea
- Gastroenterology, University of Medicine and Pharmacy Timisoara, Timisoara, Romania
| | | | - Claude B. Sirlin
- Liver Imaging Grup, University of California, Department of Radiology, San Diego, United States
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, United States
| | | | - Stephanie R. Wilson
- Department of Radiology, Foothills Medical Centre University of Calgary, Division of Ultrasound, Calgary, Canada
| | | | - Tae Kyoung Kim
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Hyun-Jung Jang
- Department of Medical Imaging, University of Toronto, Toronto, Canada
| | | | - Sue Westerway
- Ultrasound, Charles Sturt University NSW Australia, NSW, Australia
| |
Collapse
|
|
34
|
Atkinson NSS, Bryant RV, Dong Y, Maaser C, Kucharzik T, Maconi G, Asthana AK, Blaivas M, Goudie A, Gilja OH, Nuernberg D, Schreiber-Dietrich D, Dietrich CF. How to perform gastrointestinal ultrasound: Anatomy and normal findings. World J Gastroenterol 2017; 23:6931-6941. [PMID: 29097866 PMCID: PMC5658311 DOI: 10.3748/wjg.v23.i38.6931] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/30/2017] [Accepted: 06/19/2017] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal ultrasound is a practical, safe, cheap and reproducible diagnostic tool in inflammatory bowel disease gaining global prominence amongst clinicians. Understanding the embryological processes of the intestinal tract assists in the interpretation of abnormal sonographic findings. In general terms, the examination principally comprises interrogation of the colon, mesentery and small intestine using both low-frequency and high-frequency probes. Interpretation of findings on GIUS includes assessment of bowel wall thickness, symmetry of this thickness, evidence of transmural changes, assessment of vascularity using Doppler imaging and assessment of other specific features including lymph nodes, mesentery and luminal motility. In addition to B-mode imaging, transperineal ultrasonography, elastography and contrast-enhanced ultrasonography are useful adjuncts. This supplement expands upon these features in more depth.
Collapse
Affiliation(s)
- Nathan S S Atkinson
- Translational Gastroenterology Unit, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, United Kingdom
| | - Robert V Bryant
- School of Medicine, University of Adelaide, Adelaide, South Australia, 5005, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide 5000, Australia
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Christian Maaser
- Ambulanzzentrum Gastroenterologie, Klinikum Lüneburg, 21339 Lüneburg, Germany
| | - Torsten Kucharzik
- Department of Gastroenterology, Städtisches Klinikum Luneburg gGmbH, 21339 Lüneburg, Germany
| | - Giovanni Maconi
- Gastrointestinal Unit, Department of Biomedical and Clinical Sciences, “L.Sacco” University Hospital, 20157 Milan, Italy
| | - Anil K Asthana
- Department of Gastroenterology and Hepatology, The Alfred Hospital, Melbourne, Vic, Australia; Monash University, Melbourne 3004 Vic, Australia
| | - Michael Blaivas
- Piedmont Hospital, Department of Emergency Medicine, Atlanta, GA 30076, United States
| | - Adrian Goudie
- Fremantle Hospital and Health Service, Emergency Department, Fremantle, WA 6160, United States
| | - Odd Helge Gilja
- National Centre for Ultrasound in Gastroenterology, Haukeland University Hospital, Bergen N-5021, Norway
- Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway
| | - Dieter Nuernberg
- Department of Gastroenterology, Brandenburg Medical School, 16816 Neuruppin, Germany
| | | | - Christoph F Dietrich
- Med. Klinik 2, Caritas-Krankenhaus Bad Mergentheim, D-97980 Bad Mergentheim, Germany
| |
Collapse
|