Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1008
Peer-review started: July 4, 2015
First decision: July 20, 2015
Revised: August 27, 2015
Accepted: October 17, 2015
Article in press: October 20, 2015
Published online: January 21, 2016
Crohn’s disease (CD) is a chronic remittent idiopathic disease. Although the early phase of the disease is commonly characterized by inflammation-driven symptoms, such as diarrhea, the frequency of fibrostenotic complications in patients with CD increases over the long-term course of the disease. This review presents the current diagnostic options for assessing CD-associated strictures. In addition to the endoscopic evaluation of CD strictures, this review summarizes the currently available imaging modalities, including ultrasound and cross-sectional imaging techniques. In addition to stricture detection, differentiating between the primarily inflammatory strictures and the predominantly fibrotic ones is essential for selecting the appropriate treatment strategy (anti-inflammatory medical treatment vs endoscopical or surgical approaches). Therefore, recent imaging advances, such as contrast-enhanced ultrasound and ultrasound elastography, contribute to the development of non-invasive non-radiating imaging of CD-associated strictures. Finally, novel magnetic resonance imaging techniques, such as diffusion-weighted, motility and magnetization transfer imaging, as well as 18F-FDG PET/CT, molecular imaging approaches and biomarkers, are critically reviewed with regard to their potential role in assessing stricturing CD.
Core tip: Stricturing Crohn’s disease (CD) significantly decreases patients’ quality of life and often represents a challenging treatment situation that may lead to hospitalization and surgery. Differentiating between the predominantly inflammatory strictures and the primarily fibrotic strictures is essential for selecting the appropriate treatment approach (anti-inflammatory medical treatment vs endoscopic or surgery-based interventions). This review summarizes the available diagnostic procedures and emphasizes the use of endoscopy and imaging modalities, including ultrasound and cross-sectional imaging. Finally, promising recent imaging advances that might enable a more specific characterization of CD-associated strictures in the future are presented.