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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2016; 22(3): 1008-1016
Published online Jan 21, 2016. doi: 10.3748/wjg.v22.i3.1008
Assessment of stricturing Crohn's disease: Current clinical practice and future avenues
Dominik Bettenworth, Tobias M Nowacki, Friederike Cordes, Boris Buerke, Frank Lenze
Dominik Bettenworth, Tobias M Nowacki, Friederike Cordes, Frank Lenze, Department of Medicine B, University Hospital of Muenster, 48149 Muenster, Germany
Boris Buerke, Department of Clinical Radiology, University Hospital of Muenster, 48149 Muenster, Germany
Author contributions: Bettenworth D and Nowacki TM equally contributed to this manuscript; Bettenworth D, Nowacki TM and Lenze F contributed to the design of the review, literature search, manuscript writing and final revision of the article; Cordes F and Buerke B contributed to the literature search, manuscript writing and final revision of the article; all of the authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no potential conflicts of interest to disclose. The present study received no financial support.
Open-Access: 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/
Correspondence to: Frank Lenze, MD, Department of Medicine B, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, D-48149 Muenster, Germany. frank.lenze@ukmuenster.de
Telephone: +49-251-8347661 Fax: +49-251-8347576
Received: July 1, 2015
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
Abstract

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

Keywords: Crohn’s disease, Inflammatory bowel disease, Intestinal stricture, Endoscopy, Magnetic resonance imaging, Ultrasound, Computed tomography, 18F-FDG PET/CT CEUS, Elastography

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.