Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis

Amanda Vestito; Giovanni Marasco; Giovanni Maconi; Davide Festi; Franco Bazzoli; Rocco Maurizio Zagari

doi:10.1055/a-0865-1842

Ultraschall in der Medizin - European Journal of Ultrasound, Table of Contents

Ultraschall Med 2019; 40(05): 646-654
DOI: 10.1055/a-0865-1842

Original Article

Role of Ultrasound Elastography in the Detection of Fibrotic Bowel Strictures in Patients with Crohn’s Disease: Systematic Review and Meta-Analysis

Rolle der Ultraschall-Elastografie bei der Erkennung von fibrotischen Darmstrikturen bei Patienten mit Morbus Crohn: Systematischer Review und Metaanalyse

Amanda Vestito

¹Department of Digestive Diseases, Gastroenterology Unit, Bologna, Italy

,

Giovanni Marasco

¹Department of Digestive Diseases, Gastroenterology Unit, Bologna, Italy

²Department of Medical and Surgical Sciences, University of Bologna, Italy

,

Giovanni Maconi

³Gastroenterology Unit, Department of Biomedical and Clinical Sciences, “L.Sacco”-University-Hospital, Milan, Italy

,

Davide Festi

¹Department of Digestive Diseases, Gastroenterology Unit, Bologna, Italy

²Department of Medical and Surgical Sciences, University of Bologna, Italy

,

Franco Bazzoli

¹Department of Digestive Diseases, Gastroenterology Unit, Bologna, Italy

²Department of Medical and Surgical Sciences, University of Bologna, Italy

,

Rocco Maurizio Zagari

¹Department of Digestive Diseases, Gastroenterology Unit, Bologna, Italy

²Department of Medical and Surgical Sciences, University of Bologna, Italy

› Author Affiliations

Abstract

Purpose To perform a systematic review with meta-analysis to assess whether ultrasound elastography can have a diagnostic role in detecting fibrotic bowel strictures in patients with Crohn’s disease.

Materials and Methods MEDLINE via the PubMed, Ovid Embase, Scopus and Cochrane Library databases, and abstracts of international conference proceedings were searched up to March 31, 2018. Studies were included if they assessed the performance of abdominal ultrasound elastography in detecting fibrotic bowel strictures in patients with Crohn’s disease using histology or the need for surgery after medical treatment as a reference standard. The quality of the studies was assessed using Quality Assessment of Diagnostic Accuracy Studies.

Results 6 studies including a total of 217 patients with Crohn’s disease and 231 bowel segments, of which 76 were bowel segments with fibrotic stricture, were selected. Three studies used strain ratio and three studies used strain value as parameters of bowel stiffness. Both the pooled standardized mean strain ratio and the pooled standardized mean strain value were higher in bowel segments with fibrotic strictures than in those without fibrotic strictures with a standardized mean difference of 0.85 (95 % confidence level [CI]: 0 to 1.71; p = 0.05) and 1.0 (95 % CI: –0.11 to 2.10; p = 0.08), respectively. There was a high heterogeneity between studies. All studies were at “high risk” or “unclear risk” of bias.

Conclusion Ultrasound elastography could be able to detect fibrotic bowel strictures in patients with Crohn’s disease. Well-designed high quality diagnostic studies with a large sample size are needed.

Zusammenfassung

Ziel Durchführung eines systematischen Reviews mit Meta-Analyse, um zu beurteilen, ob Ultraschall-Elastografie eine diagnostische Rolle beim Erkennen fibrotischer Darmstrikturen bei Patienten mit Morbus Crohn spielen kann.

Material und Methoden Es wurden MEDLINE über die Datenbanken PubMed, Ovid Embase, Scopus und Cochrane Library sowie die Abstracts aus den Tagungsbänden internationaler Konferenzen bis zum 31. März 2018 durchsucht. Aufgenommen wurden Studien, wenn sie die Leistung der abdominalen Ultraschall-Elastografie bezüglich der Erkennung fibrotischer Darmstrikturen bei Patienten mit Morbus Crohn bewerteten und wenn als Referenzstandard eine histologische Untersuchung oder eine notwendige Operation im Anschluss an medizinische Behandlung durchgeführt wurde. Die Qualitätsbeurteilung der Studien erfolgte mittels QUADAS („Quality Assessment of Diagnostic Accuracy Studies“).

Ergebnisse 6 Studien wurden ausgewählt, die insgesamt 217 Patienten mit Morbus Crohn und 231 Darmsegmente, darunter 76 Darmsegmente mit fibrotischer Striktur, einschlossen. 3 Studien verwendeten die Strain-Ratio und die 3 anderen den Strain-Value als Parameter für die Darmsteifigkeit. Sowohl die gepoolte standardisierte mittlere Strain-Ratio als auch der gepoolte standardisierte mittlere Strain-Value waren in Darmsegmenten mit fibrotischen Strikturen höher als in solchen ohne fibrotische Strikturen. Die standardisierte Mittelwertdifferenz betrug mit fibrotischen Strikturen 0,85 (95 % Konfidenzniveau [CI]: 0 bis 1,71; p = 0,05) und ohne Strikturen 1,0 (95 % CI: –0,11 bis 2,10; p = 0,08). Es gab eine große Heterogenität zwischen den Studien. Alle Studien hatten ein „hohes" oder „nicht eindeutiges Risiko“ für Bias.

Schlussfolgerung Die Ultraschall-Elastografie könnte fibrotische Darmstrikturen bei Patienten mit Morbus Crohn nachweisen. Erforderlich sind gut konzipierte, qualitativ hochwertige Diagnosestudien mit ausreichender Stichprobengröße.

Key words

ultrasound elastography - Crohn’s disease - fibrotic bowel stricture - gastrointestinal tract

Full Text

References

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Supplementary Material

Supplementary Material