Imaging and endoscopic tools in pediatric inflammatory bowel disease: What’s new?

Abstract

Pediatric inflammatory bowel disease (IBD) is a chronic inflammatory disorder, with increasing incidence and prevalence worldwide. There have been recent advances in imaging and endoscopic technology for disease diagnosis, treatment, and monitoring. Intestinal ultrasound, including transabdominal, transperineal, and endoscopic, has been emerging for the assessment of transmural bowel inflammation and disease complications (e.g., fistula, abscess). Aside from surgery, IBD-related intestinal strictures now have endoscopic treatment options including through-the-scope balloon dilatation, injection, and needle knife stricturotomy and new evaluation tools such as endoscopic functional lumen imaging probe. Unsedated transnasal endoscopy may have a role in patients with upper gastrointestinal Crohn’s disease or those with IBD with new upper gastrointestinal symptoms. Improvements to dysplasia screening in pediatric patients with longstanding colonic disease or primary sclerosing cholangitis hold promise with the addition of virtual chromoendoscopy and ongoing research in the field of artificial intelligence-assisted endoscopic detection. Artificial intelligence and machine learning is a rapidly evolving field, with goals of further personalizing IBD diagnosis and treatment selection as well as prognostication. This review summarized these advancements, focusing on pediatric patients with IBD.

Keywords: Intestinal ultrasound; Endoscopy; Inflammatory bowel disease; Pediatrics; Imaging

Core Tip: Recent advances to imaging and endoscopic techniques and technology have improved the diagnosis, treatment, and monitoring of pediatric patients with inflammatory bowel disease. Options are now less invasive and can help avoid the repeat need for general anesthesia during endoscopy and imaging. Point-of-care ultrasound (transabdominal, transperineal, endoscopic), through-the-scope imaging (endoscopic functional lumen imaging probe) and treatment tools (balloon dilatation, injection, knife stricturotomy), unsedated transnasal endoscopy, virtual chromoendoscopy, and artificial intelligence were summarized in this current review.