Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
J Crohns Colitis. 2022 Sep 8;16(9):1493-1504. doi: 10.1093/ecco-jcc/jjac052.
Intestinal ultrasound [IUS] has been increasingly reported to distinguish inflammatory or fibrotic intestinal stenosis in Crohn's disease [CD] patients. However, the diagnostic value is unclear. This systematic review and meta-analysis aimed to assess the diagnostic role of different modes of IUS parameters.
We searched PubMed, Embase, Web of Science, and Cochrane Library from inception to August 2021. Regarding effect sizes, weighted mean differences [WMDs] or standardised mean differences [SMDs] were used. We pooled data using a random-effects or fixed-effects model according to heterogeneity. The diagnostic accuracy of IUS for distinguishing fibrosis was pooled.
A total of 19 studies were retained for qualitative analysis, and 14 were included in the meta-analysis [with 511 total subjects and 635 bowel segments]. In patients with fibrotic stenosis, the pooled WMDs for bowel wall thickness were 1.30 mm (95% confidence interval [CI]: 0.69-1.91) thicker than in patients with inflammatory stenosis, and the pooled SMDs for strain value and strain ratio were 0.80 [95% CI: 0.41-1.20] and 1.08 [95% CI: 0.55-1.60] harder than in patients with inflammatory stenosis, respectively. The percentage of maximal enhancement of fibrotic stenosis was lower than that of inflammatory stenosis [WMD -10.03; 95% CI: -17.91- -2.16]. The diagnostic accuracy of IUS was not performed because only a few studies provided relevant diagnostic indicators, and these studies used different modes and parameters.
IUS currently is inaccurate to differentiate fibrotic or inflammatory stenosis in CD patients, and more studies assessing the significance of each parameter and its cut-off value in different modes of IUS are needed to be conducted in the future.
肠超声[IUS]已被越来越多地报道用于区分克罗恩病[CD]患者的炎症性或纤维性肠狭窄。然而，其诊断价值尚不清楚。本系统评价和荟萃分析旨在评估不同模式的 IUS 参数的诊断作用。
我们从成立到 2021 年 8 月在 PubMed、Embase、Web of Science 和 Cochrane Library 进行了检索。关于效应量，使用了加权均数差[WMD]或标准化均数差[SMD]。根据异质性，我们使用随机效应或固定效应模型汇总数据。汇总了 IUS 用于区分纤维化的诊断准确性。
共纳入 19 项研究进行定性分析，其中 14 项研究纳入荟萃分析[共有 511 名受试者和 635 个肠段]。在纤维性狭窄患者中，肠壁厚度的合并 WMD 比炎症性狭窄患者厚 1.30mm（95%置信区间[CI]：0.69-1.91），应变值和应变比的合并 SMD 分别为 0.80（95%CI：0.41-1.20）和 1.08（95%CI：0.55-1.60）更硬。纤维性狭窄的最大增强百分比低于炎症性狭窄[WMD-10.03；95%CI：-17.91- -2.16]。由于只有少数研究提供了相关的诊断指标，而且这些研究使用了不同的模式和参数，因此没有进行 IUS 的诊断准确性。
IUS 目前无法区分 CD 患者的纤维性或炎症性狭窄，需要更多研究评估不同模式的 IUS 中每个参数的意义及其截断值。
