Gauci James, Sammut Lara, Sciberras Martina, Piscopo Naomi, Micallef Kristian, Cortis Kelvin, Ellul Pierre
Division of Gastroenterology (James Gauci, Martina Sciberras, Naomi Piscopo, Pierre Ellul), Mater Dei Hospital, Malta.
Department of Medical Imaging (Lara Sammut, Kristian Micallef, Kelvin Cortis), Mater Dei Hospital, Malta.
Ann Gastroenterol. 2018 Jul-Aug;31(4):395-405. doi: 10.20524/aog.2018.0268. Epub 2018 May 4.
Crohn's disease (CD) is a lifelong, chronic inflammatory bowel disorder. The small bowel (SB) is involved to varying extents, and the clinical course may vary from an inflammatory type to a more complicated one with stricture, fistula, and abscess formation. Esophagogastroduodenoscopy and ileocolonoscopy with biopsies are the conventional endoscopic techniques that usually establish the diagnosis. On the other hand, CD may affect SB segments that cannot be reached through these procedures. Video capsule endoscopy and enteroscopy are additional endoscopic techniques that may allow further SB evaluation in such circumstances. Computed tomographic enterography, magnetic resonance enterography, and ultrasonography are radiologic techniques that serve as a crucial adjunct to endoscopic assessment. They enable the assessment of parts of the bowel that may be difficult to reach with conventional endoscopy; this allows for the detection of active inflammation, penetrating or stricturing disease, and the appreciation of extraintestinal complications. Both endoscopic and radiologic modalities play a role in establishing the diagnosis of CD, as well as determining the disease extent, activity and response to therapy. This review is intended to evaluate these modalities in terms of specificity, sensitivity, potential side-effects, and limiting factors. This should serve as a guide to the clinician for establishing the most appropriate and reliable test within a particular clinical context.
克罗恩病（CD）是一种终身性的慢性炎症性肠病。小肠（SB）会受到不同程度的累及，临床病程可能从炎症型到伴有狭窄、瘘管和脓肿形成的更复杂型不等。食管胃十二指肠镜检查和带活检的回结肠镜检查是通常用于确诊的传统内镜技术。另一方面，CD可能会累及通过这些检查无法到达的小肠节段。视频胶囊内镜检查和小肠镜检查是其他内镜技术，在这种情况下可能有助于对小肠进行进一步评估。计算机断层扫描小肠造影、磁共振小肠造影和超声检查是放射学技术，是内镜评估的重要辅助手段。它们能够评估传统内镜可能难以到达的肠段；这有助于检测活动性炎症、穿透性或狭窄性疾病以及发现肠外并发症。内镜和放射学检查方法在CD的诊断、疾病范围的确定、活动性评估以及治疗反应判断中均发挥作用。本综述旨在从特异性、敏感性、潜在副作用和限制因素等方面对这些检查方法进行评估。这应为临床医生在特定临床背景下选择最合适、最可靠的检查提供指导。
