From the Department of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, New York, NY.
the Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada.
J Pediatr Gastroenterol Nutr. 2023 Feb 1;76(2):142-148. doi: 10.1097/MPG.0000000000003649. Epub 2022 Oct 28.
Crohn disease and ulcerative colitis are chronic inflammatory bowel diseases (IBD) often diagnosed in childhood. A strict monitoring strategy can potentially alter the disease course and facilitate early effective treatment before irreversible bowel damage occurs. Serial colonoscopy in children, the gold standard for monitoring, is impractical. Accurate, real-time, noninvasive markers of disease activity are needed. Intestinal ultrasound is an accurate, noninvasive, real-time, point-of-care, cross-sectional imaging tool used to monitor inflammation in pediatric IBD patients in Europe, Canada, and Australia. It is now emerging in a few expert centers in the United States as a safe, non-radiating, inexpensive, bedside tool used by the treating gastroenterologist for real-time decision-making. Unlike the standard biomarkers of pediatric IBD activity, C-reactive protein, and fecal calprotectin, intestinal ultrasound (IUS) facilitates disease localization, characterizes severity, extent, and accurately detects complications. Perhaps most importantly, IUS may enhance shared understanding and ease the burden of treatment decision-making for both the gastroenterologist and the patient. There is a lack of standardization for bedside IUS among pediatric gastroenterologists. The purpose is to outline a standardized approach to pediatric bedside IUS, including basic equipment requirements and technique, patient selection, preparation and positioning, technical considerations and limitations, documentation of mesenteric and luminal features of IBD, characterization of penetrating disease and strictures, and provide a proposed pediatric IUS monitoring algorithm to guide care.
克罗恩病和溃疡性结肠炎是常见于儿童的慢性炎症性肠病（IBD）。严格的监测策略可能会改变疾病进程，并在不可逆的肠道损伤发生之前，尽早进行有效治疗。儿童的结肠镜检查是监测疾病的金标准，但并不实际。我们需要准确、实时、非侵入性的疾病活动标志物。肠道超声是一种准确、非侵入性、实时、床边、横断面成像工具，用于监测欧洲、加拿大和澳大利亚的儿科 IBD 患者的炎症。目前，在美国的一些专家中心，它作为一种安全、非辐射、廉价的床边工具，由治疗胃肠病学家用于实时决策，也开始出现。与儿科 IBD 活动的标准生物标志物 C 反应蛋白和粪便钙卫蛋白不同，肠道超声（IUS）有助于疾病定位、特征严重程度、范围，并能准确检测并发症。也许最重要的是，IUS 可能会增强医患双方对治疗决策的共同理解，并减轻治疗决策的负担。儿科胃肠病学家在床边 IUS 方面缺乏标准化。本指南旨在概述一种标准化的儿科床边 IUS 方法，包括基本设备要求和技术、患者选择、准备和定位、技术注意事项和局限性、记录 IBD 的肠系膜和肠腔特征、穿透性疾病和狭窄的特征，并提供一个建议的儿科 IUS 监测算法来指导治疗。
