Imaging and endoscopic tools in pediatric inflammatory bowel disease: What's new?

Abstract

Pediatric inflammatory bowel disease (IBD) is a chronic inflammatory disorder, with increasing incidence and prevalence worldwide. There have been recent advances in imaging and endoscopic technology for disease diagnosis, treatment, and monitoring. Intestinal ultrasound, including transabdominal, transperineal, and endoscopic, has been emerging for the assessment of transmural bowel inflammation and disease complications (e.g., fistula, abscess). Aside from surgery, IBD-related intestinal strictures now have endoscopic treatment options including through-the-scope balloon dilatation, injection, and needle knife stricturotomy and new evaluation tools such as endoscopic functional lumen imaging probe. Unsedated transnasal endoscopy may have a role in patients with upper gastrointestinal Crohn's disease or those with IBD with new upper gastrointestinal symptoms. Improvements to dysplasia screening in pediatric patients with longstanding colonic disease or primary sclerosing cholangitis hold promise with the addition of virtual chromoendoscopy and ongoing research in the field of artificial intelligence-assisted endoscopic detection. Artificial intelligence and machine learning is a rapidly evolving field, with goals of further personalizing IBD diagnosis and treatment selection as well as prognostication. This review summarized these advancements, focusing on pediatric patients with IBD.

Keywords: Endoscopy; Imaging; Inflammatory bowel disease; Intestinal ultrasound; Pediatrics.

Figure 1

A transabdominal intestinal ultrasound image demonstrating an inflamed, thickened bowel wall of the terminal ileum in a pediatric patient with Crohn’s disease.

Figure 2

Endoscopic images demonstrating a through-the-scope balloon dilatation of an intestinal stricture in a pediatric patient with Crohn’s disease. A: Predilatation; B: Balloon dilatation; C: Postdilatation.