title: Bowel Ultrasonography in the Management of Crohn's Disease. A Review with Recommendations of an International Panel of Experts.
abstract: BACKGROUND
  Bowel ultrasonography (US) is considered a useful technique for assessing mural inflammation and complications in Crohn's disease (CD). The aim of this review is to appraise the evidence on the accuracy of bowel US for CD. In addition, we aim to provide recommendations for its optimal use.
  
  
  METHODS
  Publications were identified by literature search from 1992 to 2014 and selected based on predefined criteria: 15 or more patients; bowel US for diagnosing CD, complications, postoperative recurrence, activity; adequate reference standards; prospective study design; data reported to allow calculation of sensitivity, specificity, agreement, or correlation values; articles published in English.
  
  
  RESULTS
  The search yielded 655 articles, of which 63 were found to be eligible and retrieved as full-text articles for analysis. Bowel US showed 79.7% sensitivity and 96.7% specificity for the diagnosis of suspected CD, and 89% sensitivity and 94.3% specificity for initial assessment in established patients with CD. Bowel US identified ileal CD with 92.7% sensitivity, 88.2% specificity, and colon CD with 81.8% sensitivity, 95.3% specificity, with lower accuracy for detecting proximal lesions. The oral contrast agent improves the sensitivity and specificity in determining CD lesions and in assessing sites and extent.
  
  
  CONCLUSIONS
  Bowel US is a tool for evaluation of CD lesions in terms of complications, postoperative recurrence, and monitoring response to medical therapy; it reliably detects postoperative recurrence and complications, as well as offers the possibility of monitoring disease progression.
authors.affiliation: *Gastroenterology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; †Ambulanzzentrum Gastroenterologie am Klinikum Lüneburg, Lüneburg, Germany; ‡Klinik für Allgemeine Innere Medizin und Gastroenterologie, Lüneburg, Germany; §Digestive Disease Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ‖Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota; ¶Division of Gastroenterology, Department of Medicine, University of Calgary, Calgary, Canada; **Department of Clinical Sciences, L. Sacco University Hospital, Milan, Italy; ††University Hospital Erlangen, Erlangen, Germany; and ‡‡Department of Gastroenterology and Hepatology, Tokyo Medical and Dental University Hospital, Tokyo, Japan.
authors.forename: Emma
authors.initials: E
authors.lastname: Calabrese
authors.forename: Christian
authors.initials: C
authors.lastname: Maaser
authors.forename: Francesca
authors.initials: F
authors.lastname: Zorzi
authors.forename: Klaus
authors.initials: K
authors.lastname: Kannengiesser
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hanauer
authors.forename: David H
authors.initials: DH
authors.lastname: Bruining
authors.forename: Marietta
authors.initials: M
authors.lastname: Iacucci
authors.forename: Giovanni
authors.initials: G
authors.lastname: Maconi
authors.forename: Kerri L
authors.initials: KL
authors.lastname: Novak
authors.forename: Remo
authors.initials: R
authors.lastname: Panaccione
authors.forename: Deike
authors.initials: D
authors.lastname: Strobel
authors.forename: Stephanie R
authors.initials: SR
authors.lastname: Wilson
authors.forename: Mamoru
authors.initials: M
authors.lastname: Watanabe
authors.forename: Francesco
authors.initials: F
authors.lastname: Pallone
authors.forename: Subrata
authors.initials: S
authors.lastname: Ghosh
mesh_terms: D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000601:surgery; D019468:Disease Management; D006801:Humans; D007390:International Agencies; D017410:Practice Guidelines as Topic / Q000592:standards*; D014463:Ultrasonography