J Pediatr Gastroenterol Nutr. 2022 Oct 29. doi: 10.1097/MPG.0000000000003649.Online ahead of print.

Amelia Kellar ¹, Michael Dolinger ¹, Kerri L Novak ², Mallory Chavannes ³, Marla Dubinsky ¹, Hien Huynh ⁴

Author information

¹Department of Pediatric Gastroenterology, Icahn School of Medicine at Mount Sinai, Susan and Leonard Feinstein Inflammatory Bowel Disease Center, New York, NY.

²Inflammatory Bowel Disease Clinic, Division of Gastroenterology and Hepatology University of Calgary, Calgary Alberta.

³Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA.

⁴Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition University of Alberta, Edmonton Alberta.

Abstract

Crohn's disease (CD) and ulcerative colitis (UC) 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, non-invasive markers of disease activity are needed. Intestinal ultrasound is an accurate, non-invasive, 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, 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 amongst 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.