Cuffari MD

Associate Professor of Pediatrics,

George Washington School of Medicine, USA

Treatment – Surgery:

Indications Failure of medical therapy recurrent obstruction Perforation Fistula/abscess Haemorrhage Growth failure

Indications:

Failure of medical therapy-Definition- 4 anti-TNF/biosimilars 3 classes biologics/small molecule therapies;Recurrent obstruction- proximal dilation Fibroticvs inflammatory vs mixed Small bowel barium enema vs CT enterography vs MRE

Hypothesis:

Contrast enhanced ultrasound differentiates between reversible inflammation and irreversible fibrosis in patients with Crohn’s disease complicated by ileal stricture

Contrast Enhanced Ultrasound (CEUS):

  • Advantages Radiation free Portable and can be performed at the bedside Fast exam  No anesthesia or sedation required Provides quantifiable kinetics that reflect the dynamic pattern of blood perfusion in the examined tissue Wash-in slope (dB/sec) Peak intensity (dB) Time to peak intensity (sec) Area under the curve (dB/sec) Quantifiable elastography

Study Aims:

Correlate CEUS kinetics with colonoscopic and histopathologic findings:

Patients with fibrotic ileal strictures will have decreased ileal kinetic values compared to healthy jejunum. Patients with acute ileal inflammatory strictures will have increased ileal kinetic values compared to healthy jejunum.

Secondary Outcomes:

Compare conventional radiological studies to CEUS in differentiating distal ileal strictures in patients with Crohn’s disease. Sidhu SD, et. Al. PediatrGastroenterolHepatolNutr. 2023

Study Design:

Population Inclusion Criteria ≤ 22 years of age Followed in the Division of Pediatric Gastroenterology Diagnosis of Crohn’s Disease based on histopathology obtained from endoscopy/colonoscopy Clinical or radiologic suspicion for ideal stricture Exclusion Criteria History of anaphylaxis to Lumason / CEUS

Methods:

Prospective recruitment and elective enrollment  in the Division of Pediatric Gastroenterology; CEUS performed by pediatric radiologist; CEUS kinetic assessment by Dr.Sidhu, reviewed with the Radiologist; Histopathologic evaluation of resected terminal ileum by pediatric pathologist; Blinded to clinical history and results of CEUS Application of previously validated histopathologic scoring system to the narrowest portion of resected ileum

Conclusions:

CEUS is a relatively inexpensive bedside radiological tool to evaluated ileal strictures in children with Crohn’s disease; Elastography results would suggest that most strictures are mixed inflammatory and fibrotic strictures; Enhanced AUC correlates with muscularispropria hypertrophy in the background of focal luminal obstruction and increased intestinal resistance; Future studies will help support the role of CEUS in guiding medical and surgical therapy. Sidhu SD, et. al. PediatrGastroenterolHepato l Nutr. 2023