Manzotti C, Colombo F, Zurleni T, Danelli P, Maconi G. Prognostic role of intestinal ultrasound in Crohn’s disease. World J Gastroenterol 2023; 29(23): 3595-3605 [PMID: 37398888 DOI: 10.3748/wjg.v29.i23.3595]
Corresponding Author of This Article
Francesco Colombo, MD, Assistant Professor, Division of General Surgery, Department of Biomedical and Clinical Sciences, University of Milan, L.Sacco University Hospital, Via Giovanni Battista Grassi 74, Milano 20157, Italy. colombo.francesco@asst-fbf-sacco.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastroenterol. Jun 21, 2023; 29(23): 3595-3605 Published online Jun 21, 2023. doi: 10.3748/wjg.v29.i23.3595
Prognostic role of intestinal ultrasound in Crohn’s disease
Cristina Manzotti, Francesco Colombo, Tommaso Zurleni, Piergiorgio Danelli, Giovanni Maconi
Cristina Manzotti, Giovanni Maconi, Gastroenterology Unit, Department of Biomedical and Clinical Sciences, University of Milan, L.Sacco University Hospital, Milano 20157, Italy
Francesco Colombo, Tommaso Zurleni, Piergiorgio Danelli, Division of General Surgery, Department of Biomedical and Clinical Sciences, University of Milan, L.Sacco University Hospital, Milano 20157, Italy
Author contributions: Manzotti C and Maconi G gave substantial contributions to conception and design of the review, and literature review; Manzotti C drafted and edited the article; Colombo F and Maconi G revised the manuscript critically for important intellectual content; Colombo F, Zurleni T, and Danelli P worked together for the final approval of the version to be published.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Francesco Colombo, MD, Assistant Professor, Division of General Surgery, Department of Biomedical and Clinical Sciences, University of Milan, L.Sacco University Hospital, Via Giovanni Battista Grassi 74, Milano 20157, Italy. colombo.francesco@asst-fbf-sacco.it
Received: March 9, 2023 Peer-review started: March 9, 2023 First decision: March 20, 2023 Revised: April 5, 2023 Accepted: May 23, 2023 Article in press: May 23, 2023 Published online: June 21, 2023 Processing time: 98 Days and 19.5 Hours
Abstract
The majority of patients affected by Crohn’s disease (CD) develop a chronic condition with persistent inflammation and relapses that may cause progressive and irreversible damage to the bowel, resulting in stricturing or penetrating complications in around 50% of patients during the natural history of the disease. Surgery is frequently needed to treat complicated disease when pharmacological therapy failes, with a high risk of repeated operations in time. Intestinal ultrasound (IUS), a non-invasive, cost-effective, radiation free and reproducible method for the diagnosis and follow-up of CD, in expert hands, allow a precise assessment of all the disease manifestations: Bowel characteristics, retrodilation, wrapping fat, fistulas and abscesses. Moreover, IUS is able to assess bowel wall thickness, bowel wall stratification (echo-pattern), vascularization and elasticity, as well as mesenteric hypertrophy, lymph-nodes and mesenteric blood flow. Its role in the disease evaluation and behaviour description is well assessed in literature, but less is known about the potential space of IUS as predictor of prognostic factors suggesting response to a medical treatment or postoperative recurrence. The availability of a low cost exam as IUS, able to recognize which patients are more likely to respond to a specific therapy and which patients are at high risk of surgery or complications, could be a very useful instrument in the hands of IBD physician. The aim of this review is to present current evidence about the prognostic role that IUS can show in predicting response to treatment, disease progression, risk of surgery and risk of post-surgical recurrence in CD.
Core Tip: Intestinal ultrasound (IUS) and magnetic resonance enterography are better tolerated and safer than endoscopy, with IUS more easily available and less expensive than magnetic resonance imaging. Moreover, IUS allows complete visualization of the small-bowel even in patients with stenoses and/or severe inflammation, and can assess for extraintestinal disease. In addition, IUS may predict outcomes better than endoscopic mucosal assessment, possibly identifying more relevant therapeutic targets. This review discusses the role of IUS in Crohn’s disease not only as first line investigation but as an extremely useful instrument in predicting response to medical treatment, disease evolution and risk of recurrence before and after surgery.
