Small Intestine Contrast Ultrasonography Research Articles

Small Intestinal Contrast Ultrasonography (SICUS) in Crohn's Disease: Systematic Review and Meta-Analysis.

The diagnosis of Crohn's Disease (CD) is based on a combination of clinical symptoms, laboratory tests, endoscopy, and imaging data. In Small Intestine Contrast Ultrasonography (SICUS), the ingestion of a macrogol solution as an oral contrast medium may optimize image quality. We performed a meta-analysis to evaluate the diagnostic performance of SICUS for CD. A literature search was performed in August 2023. We selected only studies where SICUS was compared to a technique that allows the assessment of the whole gastrointestinal tract, such as an MRE, a CT scan, or a surgical evaluation. We estimated pooled weighted sensitivity, specificity, and likelihood ratio for positive and negative tests (PLR/NLR) of SICUS. Summary receiver operating characteristic curves (SROC) were drawn, and pooled areas under the curve (AUC) were calculated. Five studies with 325 CD patients were included. SICUS showed a pooled sensitivity for the diagnosis of 95% (95% confidence interval CI 89-99%), a specificity = 77% (95% CI 60-90%), and the AUC was 0.94. SICUS demonstrated a pooled sensitivity for strictures of 78% (95% CI 63-88%) and a specificity = 96% (95% CI 85-99%), with AUC = 0.93. For abscesses, SICUS demonstrated a pooled sensitivity of 100% (95% CI 59-100%) and a specificity of 90% (95% CI 74-98%). Fistulae were detected with a pooled sensitivity of 77% (95% CI 46-95%) and a specificity of 92% (95% CI 75-99%). SICUS demonstrated excellent diagnostic performance compared to the gold standard despite some clinical scenarios (stenosis/fistulae) showing suboptimal diagnostic effectiveness.

Le malattie infiammatorie croniche intestinali: aspetti clinici

Inflammatory bowel diseases (IBD) are chronic diseases of the gastrointestinal tract that have been steadily increasing in recent years, particularly in pediatric age. The clinical manifestations of IBD differ according to the forms (Crohn’s m., ulcerative rectocolitis, undifferentiated colitis), and can be distinguished into intestinal and extra-intestinal. The laboratory contributes at various levels in the diagnosis of IBD, from the use of inflammation markers, to the most commonly used serologic markers (ASCA and p-ANCA), to fecal markers (calprotectin). Ultrasonography of the bowel loops is the most recommended noninvasive instrumental investigation to date because of its noninvasiveness, safety, and low cost. The major limitation of ultrasonography is operator-dependent variability, although recently, the use of new technique, SICUS (small intestine contrast ultrasonography), has been shown to greatly improve the sensitivity of the examination and reduce inter-operator variability. Endoscopic investigation coupled with histologic analysis of biopsy specimens is, to date, the gold standard for making a diagnosis of IBD, playing a key role in the diagnosis and therapy of these conditions. The primary goals of pediatric IBD therapy are to induce and maintain a sustained remission with prevention of clinical relapse, optimize growth and pubertal development, and improve the patient’s quality of life. The importance of the genetic and epigenetic component in the phenotypic expression of IBD is increasingly widely demonstrated. These aspects will be the subject of a forthcoming contribution.

Response Assessed by Ultrasonography as Target of Biological Treatment for Crohn’s Disease

Mucosal healing, determined by ileocolonoscopy, is a goal for treatment of Crohn's disease (CD), but this is an invasive assessment procedure. We investigated whether response to tumor necrosis factor (TNF) antagonists, determined by small-intestine contrast ultrasonography, associates with long-term outcomes. We performed observational study of 80 patients with CD treated with anti-TNF agents for at least 1 year who underwent serial small intestine contrast ultrasonography (SICUS) at the University of Rome, in Italy. SICUS was used to evaluate disease site (based on bowel wall thickness), extent of lesions, and presence of complications. Inclusion criteria required pre-therapy SICUS with follow-up SICUS after 18 months. At second SICUS, patients were assigned to categories of complete or partial responder or non-responder. CD-related outcomes (corticosteroid need, hospitalization, and surgery) were assessed at 1 year from the second SICUS, using multivariate models, and were analyzed after long term follow up (5 years) using Kaplan-Meier survival analysis. Based on SICUS, after a median of 18 months, 36 patients (51%) were complete responders, 30 were partial responders (34%), and 13 were non-responders (15%). At 1 year from the second SICUS, no patients with a complete response, based on ultrasonography, underwent surgery, in comparison to partial responders (P = .0003) or non-responders (P = .001). Complete respondersused smaller amounts of corticosteroids than partial responders (P = .0001) or non-responders (P < .0001). Complete responders required fewer hospitalizations than non-responders (P = .001). Kaplan-Meier survival analysis of long-term follow up data demonstrated a lower cumulative probability of need for surgery, hospitalization, and need for steroids among SICUS-categorized complete responders (P < .0001, P = .003 and P = .0001 respectively) than SICUS-categorized non-responders. In patients with CD, response to anti-TNF agents, determined by SICUS, is associated with better long-term outcomes than partial or no response. Ultrasonographic assessment therefore provides a relatively non-invasive method for monitoring response to treatment in patients withCD.

New cross-sectional imaging in IBD.

Cross-sectional imaging, namely ultrasound, CT and MR enterography, complements clinical and endoscopic monitoring of activity and complications in IBD, and emerging new radiological technologies may have clinical applications in the near future. This review offers an update on the potential role of these new imaging methods in the management of IBD. Specific MR techniques [diffusion-weighted imaging (DWI), diffusion kurtosis imaging (DKI) and magnetization transfer] allow accurate detection of inflammation (DWI and maybe DKI) and fibrosis (magnetization transfer) in Crohn's disease, without the need of intravenous gadolinium administration. ultrasonography developments (elastography, contrast-enhanced ultrasonography, small intestine contrast ultrasonography and multispectral optoacoustic tomography) are promising techniques for evaluation of fibrosis (elastography) and inflammation (contrast ultrasonography). Dose-reduction techniques in CT allow similar quality imaging and diagnostic accuracy with lower radiation exposure. Hybrid imaging (PET/MR and PET/CT) hold promise for grading inflammation in Crohn's disease. The potential benefits of new cross-sectional imaging techniques in IBD include better inflammation grading, such as identification of mild degree of activity, which may be relevant whenever assessing response to treatment and, of uttermost importance, accurate preoperative detection and grading of fibrosis in stricturing Crohn's disease, facilitating surgical vs. medical therapeutic decisions.

Looking Beyond Mucosal Healing: Effect of Biologic Therapy on Transmural Healing in Pediatric Crohn's Disease.

Crohn's disease is a chronic inflammatory disease characterized by a progressive transmural bowel damage leading to complications. Anti-TNFα therapy is effective in achieving mucosal healing (MH), but its efficacy on transmural inflammation has been poorly investigated. The aim of this study is to evaluate, in pediatric Crohn's disease, the efficacy of anti-tumor necrosis factor α agents in inducing transmural healing (TH) as assessed by ultrasonography (US). Children with Crohn's disease requiring anti-tumor necrosis factor α therapy were prospectively enrolled. Clinical activity, laboratory tests, endoscopic activity, and transmural disease assessed by small intestine contrast US (SICUS) were evaluated at baseline (T0) and then after 9 to 12 months of therapy (T1). We evaluated US quantitative and qualitative parameters: disease extension (centimeters), bowel wall (BW) thickness >3 mm, BW vascularity and stratification strictures, and prestenotic dilatation. TH was defined as a BW thickness <3 mm and normalization of all US parameters at T1. Thirty-two patients were included. Patients with mucosal healing (MH) showed a significant decrease of BW thickness and disease extension at T1 (4.3 ± 1.4 mm and 8 ± 6.3 cm versus 6.1 ± 2.3 mm and 13 ± 5 cm at baseline, respectively) (P < 0.001). Increased vascularity of the BW was found in 80% of patients at T0 and in 18% at T1 (P < 0.001). These parameters did not change in patients without MH, despite clinical and laboratory remission. The presence of stenosis and prestenotic dilatation did not modify in any group. A complete TH was achieved in 14% of patients, all of them showing complete MH. Biologics induce clinical and laboratory remission and MH in pediatric CD. Although caution is needed due to the small sample size, our data suggest that transmural inflammation also improves during therapy, but a complete TH is achieved only in a small percentage of patients.

Small intestine contrast ultrasonography for the detection and assessment of Crohn disease: A meta-analysis.

Background:Crohn disease (CD) is a chronic relapsing disease. Imaging modalities are essential for the diagnosis and assessment of CD. Small intestine contrast ultrasonography (SICUS) is a well-tolerated, noninvasive and radiation-free modality and has shown potential in CD assessment. We aimed at evaluating the diagnostic accuracy of SICUS in the detection and assessment of small-bowel lesions and complications in CD.Methods:We searched PubMed database for relevant studies published before April 24, 2016. We integrated the true positive, false positive, false negative, and true negative into the pooled estimates of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. Forest plots were to represent the pooled results of all studies.Results:Thirteen articles were finally considered eligible. The pooled sensitivity and specificity of SICUS in detecting small-bowel lesions were 0.883 (95% confidence interval (CI) 0.847–0.913) and 0.861 (95% CI 0.828–0.890), respectively. The pooled diagnostic odds ratio was 39.123 (95% CI 20.014–76.476) and the area under the curve of summary receiver operating characteristic was 0.9273 (standard error: 0.0152). In subgroup analyses, SICUS represented fine sensitivity and specificity in proximal and distal small intestine lesion, as well as in CD-related complications such as stricture, dilation, abscess, and fistula.Conclusion:SICUS is accurate enough to make a complete assessment about the location, extent, number, and almost all kinds of complications in CD small-bowel lesions.

P125. Investigating the small bowel in paediatric Crohn’s disease: prospective comparative study between small intestine contrast ultrasonography and magnetic resonance imaging

P125. Investigating the small bowel in paediatric Crohn’s disease: prospective comparative study between small intestine contrast ultrasonography and magnetic resonance imaging

Post-operative recurrence of Crohn's disease: A prospective study at 5 years

BackgroundWe aimed to prospectively assess whether endoscopic recurrence severity at 1 year in Crohn's disease is predictive of clinical recurrence within 5 years. MethodsClinical recurrence (Crohn's Disease Activity Index>150) was assessed yearly for 5 years in Crohn's disease patients undergoing ileo-colonic resection. At 1 year, recurrence was assessed by colonoscopy (Rutgeerts’ score ≥i1 or ≥2i) and small intestine contrast ultrasonography. Results40 patients were included (23 males, median age 39 [16–69] years). Clinical recurrence occurred within 5 years in 16 (40%) patients (years 1, 2, 3, 4, 5: 2 [5%]; 10 [25%]; 4 [10%]; 2 [5%]; 4 [10%], respectively). At 1 year, endoscopic recurrence (score≥i1) occurred in 39 (97.5%) patients (score≥i2: 33 [82.5%]). Ultrasound detected lesions compatible with recurrence in 39/40 (97.5%) patients. Endoscopic score at 1 year was correlated with clinical score at 2 years (p=0.007; r=0.41). Endoscopic score at 1 year was higher in patients with (n=10) vs without (n=30) clinical recurrence at 2 years (3 [2–4] vs 2 [0–4]; p=0.003). Higher endoscopic score (>i2) at 1 year was a risk factor for clinical recurrence within 5 years (OR=0.18; 95% CI 0.04–0.71; p=0.008). ConclusionsIn Crohn's disease, severity of endoscopic recurrence at 1 year remains a predictive marker of clinical recurrence within 5 years. Small intestine contrast ultrasonography is useful for assessing 1-year recurrence.

Investigating the small bowel in pediatric Crohn's disease: Prospective comparative study between small intestine contrast ultrasonography and magnetic resonance imaging

Background: Magnetic resonance imaging (MRI) is considered the gold-standard to evaluate SB in pediatric Crohn’s disease (CD). However, MRI is expensive, requires a strong compliance and a considerable amount of oral contrast to distend intestinal lumen. Small intestine contrast ultrasonography (SICUS) is non-invasive, low cost and generally well tolerated by patients. Objectives: To compare the diagnostic accuracy of SICUS and MRI in detecting presence, site and extension of SB disease and in assessing strictures in pediatric CD. Methods: Pediatric pts with suspected or known CD were prospectively enrolled. All underwent SICUS, MRI and ileocolonoscopy, performed by blind different operators. The SB was subdivided into: jejunum, ileum, terminal ileum (TI). The statistic concordance (k) between the two techniques was calculated. For the TI sensitivity (SE) and specificity (SP) were also assessed, with endoscopy as reference standard. The one-way ANOVA was used to compare the disease extension (cm) in the different segments. Results:66 consecutive patientswere included. The overall k for the presence of lesions was=0.94 (ES 0.06; 95%CI 0.8–1. The k for segments was 0.67 (jejunum), 0.91 (ileum) and 0.91 (TI). SE and SP (%) of SICUS andMRI for TI lesions were 98, 100 and 93, 92, respectively. There was no difference (p ns) in the evaluation of disease extension between the two techniques. The k for SB strictures was 0.62. SE and SP (%) of SICUS andMRI for TI strictures were 100, 100 and 92, 87, respectively. MRI provided 7 false positive results. Conclusions: The diagnostic performance of SICUS is comparable to that ofMRI. SICUSmight represent afirst-line tool in pediatric CD, able to reduce costs and to post-pone or even avoid more invasive investigations.

Diagnosis and management of Crohn's disease.

Diagnosis and management of Crohn’s disease is based on clinical signs and symptoms combined with laboratory tests, endoscopy and imaging techniques. Endoscopy is the gold standard for the evaluation of patients with Crohn’s disease. Nevertheless, a correct diagnosis requires radiological examinations to define the extent and stage of the disease and especially to diagnose transmural complications including fistulae, abscesses and phlegmons. Computed tomography (CT) and magnetic resonance imaging (MRI) are currently indicated in the study of the gastrointestinal tract. Diagnostic sensitivity and specificity of these two methods are similar and both also present certain limitations. CT is widely used and execution time is short, whereas MRI is much less common and requires a longer execution time. However, patients with Crohn’s disease are often young, and the frequency with which they have to undergo radiological examinations should be taken into account, as several trials have suggested that a total exposure to radiation exceeding 50 mSv carries a risk of neoplastic disease. Over the past decade, ultrasound (US) has gradually been introduced to support clinical examination in the diagnosis and monitoring of patients with Crohn’s disease. Several trials have assessed the diagnostic accuracy of US compared to that of CT and MRI, and the results have led to the recommendations contained in the updated guidelines (2013) of the European Crohn’s and Colitis Organisation (ECCO). The role of endoscopy and biopsy as first-line procedures in patients with suspected Crohn’s disease is reaffirmed, and CT and MRI still remain the gold standard imaging methods in the diagnosis of intestinal involvement and transmural lesions. However, US is recommended for assessing the extent of the disease and possible inflammation of the intestinal wall, particularly referred to bowel segments, which are not reachable by the endoscope owing to strictures. Furthermore, thanks to the widespread availability and short examination time, US imaging is useful also in emergencies to obtain immediate and important diagnostic information required for management decisions. The ECCO guidelines also focus attention on the role of US in the diagnosis of extramural complications. Abscesses, fistulas and phlegmons are frequent and sometimes fatal, but they are easily detected by US with a sensitivity of over 90 %. Several applications are still being assessed, and some studies show a greater diagnostic efficacy of contrast enhanced US (CEUS) and small intestine contrast ultrasonography (SICUS) associated with power Doppler in the diagnosis of the disease and its complications. These results, as well as the encouraging results obtained by US imaging for predicting the risk of recurrence after surgery, require further confirmation. However, the obtained data suggest that US imaging could be further implemented in the study of Crohn’s disease and that this diagnostic method might become a procedure of choice in inflammatory bowel disease (IBD). The limitations of US imaging, which are linked to the patient’s bodily features and the difficult visualization of some portions of the GI tract, are not relevant to the study of Crohn’s disease. US has become one of the most user- and patient-friendly methods for assessment of the gastrointestinal tract thanks to the elevated dynamism and usability of US as well as the continuous training of increasingly specialized US operators. In line with the multidisciplinary approach, which is characteristic of SIUMB, the society and JUS have therefore requested some of the greatest experts to write a series of articles on the role of US in the study of various medical, surgical and radiological aspects of Crohn’s disease, comparing US with other diagnostic methods. We thank the Authors for the time they have dedicated to this task and for the completeness and originality of the articles. In our opinion, the result is very good. We hope you will enjoy the reading.

O-173 Evaluating The Potential Role Of Small Intestine Contrast Ultrasonography In Paediatric Crohn’s Disease: 5 Year Experience In A Single Centre

<h3>Background and aims</h3> Small intestine contrast ultrasonography (SICUS) is an emerging, non-invasive technique which accurately assesses small bowel lesions associated with Crohn’s disease (CD) in adult patients, without exposure to medical radiation. We report our 5 year experience in a paediatric cohort. <h3>Methods</h3> Patients with suspected or established CD who underwent SICUS were identified and radiological findings collated. SICUS was compared to conventional transabdominal ultrasound (TUS), ileocolonoscopy and magnetic resonance enterography (MRE). Accuracy and agreement of SICUS in detecting small bowel lesions and CD-related complications was assessed using kappa (κ) coefficient statistics. <h3>Results</h3> 93 patients (median age 16 years, range 2–20, 49 male) underwent SICUS; 58 had suspected and 35 established CD. In suspected CD, sensitivity and specificity of SICUS in detecting CD small bowel lesions were 81.82% and 100% and TUS 85.71% and 87.50%, respectively. In established CD, sensitivity and specificity of SICUS were 83.33% and 100% and TUS 80.00% and 100%, respectively. Agreement with ileocolonoscopy was fair for the presence of lesions (SICUS, κ=0.38, TUS, κ=0.31). Agreement between SICUS and ileocolonoscopy was good for detecting strictures (κ=0.66) with a sensitivity of 100% and specificity of 97.62%. Comparing SICUS and TUS with MRE, agreement for the presence of lesions was κ=0.63 and 0.53, respectively. Agreement between SICUS and MRE was good for detecting strictures (κ=0.77) and fair for assessing dilatation (κ=0.45). <h3>Conclusions</h3> SICUS offers a promising radiation-free, low cost alternative for diagnosing and monitoring paediatric CD small bowel complications. Its wider use should be adopted.

Ultrasonography in pediatric inflammatory bowel diseases

Inflammatory bowel diseases (IBD) are an heterogeneous group of chronic disorders of intestinal inflammation characterised by periods of remission and exacerbation. Crohn’s disease (CD) an ulcerative colitis (UC) are the two major clinical subtypes of IBD [1]. CD is caracterised by transmural inflammation in a non contiguos pattern anywhere from the mouth to the anus. Ileocolonic region is the most common location of disease in pediatric CD. Classically, UC involves disease that extends proximally for a variable distance from the rectus, with involvement of the superficial layers of the colonic mucosa. Pancolitis is the most frequent presentation of UC in childhood. Disease courses are different not only in childhood from adult life but olso in the different ages of pediatric patients [2]. Definitive diagnosis of IBD relies on endoscopic and histologic findings often supported by radiologic imaging. Ultrasound scanning as innocuos and ubiquitary imaging tecnique can be used both as screening diagnostic tool in patients with suspected IBD than in the clinical management of patients with proven IBD in the effort of detect extension, grade of activity and early individuation of complications in the follow-up. Ultrasound can be performed as a standard examination without preparation called transaddominal ultrasonography (TUS) or associated with previous ingestion of an oral contrast solution that produce an osmotic fluid distension of intestinal lumen for a more sensitrive and detailed valutation of sonographic aspects of the bowel wall called small intestine contrast ultrasonography (SICUS). In Crohn disease recent data in literature show that SICUS improves sensitivity in detecting small bowel lesions both in previous undiagnosed patients from 75% to 100% than in patients with proven CD from 76% to 100% compared to TUS [3]. The execution of ultrasound in the evaluation of pediatric intestinal tract requires time, good tecnique and experience of the sonographer. The main goal of this presentation is to show the most important tecnical aspects of the execution of ultrasound examination in pediatric IBD.

A Sonographic Lesion Index for Crohn's Disease Helps Monitor Changes in Transmural Bowel Damage During Therapy

Therapeutic antibodies against tumor necrosis factor α (anti-TNF) are effective in patients with Crohn's disease (CD). Mucosal healing is a surrogate marker of efficacy, but little is known about the effects of anti-TNF agents on structural damage in the intestine. Small-intestine contrast ultrasonography (SICUS) is a valuable tool for assessing CD lesions. A new sonographic quantitative index (the sonographic lesion index for CD [SLIC]) was developed to quantify changes in CD lesions detected by SICUS. We explored whether the SLIC can be used to monitor transmural bowel damage in CD patients during anti-TNF therapy. We performed a prospective study of 29 patients with ileal or ileocolonic CD treated with anti-TNF agents; patients underwent SICUS before and after scheduled induction and maintenance therapy. To determine whether changes that can be detected by SICUS occur independently of anti-TNF therapy, 7 patients with ileal CD treated with mesalamine were enrolled as controls. A clinical response was defined as steroid-free remission, with CD activity index scores less than 150. We observed significant improvements in SLIC scores and subscores after induction and maintenance therapy with anti-TNFs, compared with before therapy. SLIC scores and subscores and index classes were improved significantly in patients with vs without clinical responses. Controls had no improvements in terms of CD activity index or SLIC scores, or index classes. Sonographic assessment using the quantitative index SLIC can be used to monitor changes in transmural bowel damage during anti-TNF therapy for CD.

881 Effects of Telmisartan in Anal Sphincter Physiology in Asymptomatic Volunteers and Patients With Anal Sphincter Hypertension With Chronic Proctalgia

Background. Small intestine contrast ultrasonography (SICUS) can detect intestinal damage in patients with Crohn's disease (CD). We evaluated the diagnostic accuracy of SICUS in determining the site, extent, and complications of CD, compared with magnetic resonance (MR)-enterography as the standard. Methods. We performed a retrospective analysis of 52 patients with CD [(M=33; median age: 23, CD site: ileal 35 (67%), ileocolonic 13 (25%), jejuno-ileal, 3 (6%), colonic 1 (2%); behaviour: non-stricturing non-penetrating 8 (15%), structuring 27 (52%), penetrating 17 (33%); previous surgery 21 (40%); clinical indications: disease assessment 46 (89%), obstructive symptoms 6 (11%)] evaluated by SICUS and MRenterography 3 months apart, between January 2011 and October 2013. We evaluated disease site (based on bowel wall thickness), extent of lesions, presence of complications (stenosis, prestenotic dilation, abscess, or fistulas) using MR-Enterography as the standard. Sensitivity, specificity, and diagnostic accuracy were calculated. We determined the correlations in maximum wall thickness and disease extent in the small bowel between results from SICUS and MR-Enterography. Results. SICUS identified the site of small bowel CD with 96% sensitivity, 60% specificity, and 92% diagnostic accuracy; it identified the site of colon CD with 70% sensitivity, 92% specificity, and 87% diagnostic accuracy. Results from SICUS and MR-enterography correlated in determination of bowel wall thickness (rho=0.51) and disease extent (rho=0.72; P<.0001 for both). SICUS detected ileal stenosis with 90% sensitivity, 92% specificity, and 90% diagnostic accuracy, and pre-stenotic dilation with 66% sensitivity, 80% specificity, and 71% diagnostic accuracy. SICUS detected abscesses with 100% sensitivity, 100% specificity, and fistulas with 80% sensitivity, 81% specificity, and 81% diagnostic accuracy. Conclusion. SICUS identified lesions and complications in CD patients with high levels of sensitivity, specificity, and accuracy compared to MRenterography. SICUS might be used as an imaging tool as part of a focused diagnostic and follow up examination of patients with CD.

94 Looking Beyond Deep Remission: Effect of Biologic Therapy on Transmural Healing Evaluated by Ultrasound in Pediatric Ileal Crohn's Disease

BACKGROUND AND AIM: Therapeutic goals for Crohn's disease (CD) have evolved from a mere control of symptoms to the concept of deep remission (DR), including clinical and biomarker remission and mucosal healing (MH). Biologic therapy with anti-TNFα is effective in achieving MH. Yet, CD is a transmural disease, characterized by a progressive bowel damage leading to complications. This is the first pediatric study prospectively evaluating the efficacy of anti-TNFα therapy in inducing clinical remission, MH and transmural healing (TH) in ileal CD. METHODS: Pediatric patients (pts) with ileal CD starting biological therapy with Infliximab or Adalimumab were prospectively enrolled. All pts were Naive to biologics. Clinical activity (Pediatric Crohn's Disease Activity Index, PCDAI), laboratory tests (CRP, ESR), endoscopic activity (simple endoscopic score, SES-CD) and transmural disease assessed by small intestine contrast ultrasonography (SICUS) were evaluated before starting (T0) and after 9-12 months of therapy (T1). Complete MH was defined as a SES-CD of 0-1, partial MH as 50% decrease vs T0. At US the evaluated parameters were: extension of disease (cm), bowel wall thickness >3 mm (BWT), bowel wall vascularity, stratification of the BW (BWS), presence of stricture, fistulae and abscess. Wilcoxon signed rank test was used for pair comparison (T1-T0). RESULTS: 26 pts (mean age 13.3 ± 4, 16 males) were included. The mean PCDAI, ileal SES-CD, CRP, ESR, BWT and disease extension values significantly decreased at T1 (table). Increased bowel wall vascularity was present in 80% of pts at T0 and in 24% at T1 (p<0.0001). In pts with complete and partial MH the extension of disease and themean BWT at US were significantly reduced at T1 (p<0.02); in pts without endoscopic response the US parameters didn't change significantly, despite clinical response. Presence of strictures and BWS didn't modify during therapy in any group. CONCLUSIONS: Biologics are effective in inducing clinical and laboratory remission and in achieving MH in pediatric CD. Transmural inflammation significantly improves during therapy, however when a substantial bowel damage (stricture) is present, the effect on TH might be poorer. Further studies are needed to evaluate the impact of TH on the long term outcome of CD. CLINICAL, ENDOSCOPIC AND US DATA AT T0 AND T1

95 Exome Sequencing Analysis of Candidate Genes in Very Early Onset IBD

BACKGROUND AND AIM: Therapeutic goals for Crohn's disease (CD) have evolved from a mere control of symptoms to the concept of deep remission (DR), including clinical and biomarker remission and mucosal healing (MH). Biologic therapy with anti-TNFα is effective in achieving MH. Yet, CD is a transmural disease, characterized by a progressive bowel damage leading to complications. This is the first pediatric study prospectively evaluating the efficacy of anti-TNFα therapy in inducing clinical remission, MH and transmural healing (TH) in ileal CD. METHODS: Pediatric patients (pts) with ileal CD starting biological therapy with Infliximab or Adalimumab were prospectively enrolled. All pts were Naive to biologics. Clinical activity (Pediatric Crohn's Disease Activity Index, PCDAI), laboratory tests (CRP, ESR), endoscopic activity (simple endoscopic score, SES-CD) and transmural disease assessed by small intestine contrast ultrasonography (SICUS) were evaluated before starting (T0) and after 9-12 months of therapy (T1). Complete MH was defined as a SES-CD of 0-1, partial MH as 50% decrease vs T0. At US the evaluated parameters were: extension of disease (cm), bowel wall thickness >3 mm (BWT), bowel wall vascularity, stratification of the BW (BWS), presence of stricture, fistulae and abscess. Wilcoxon signed rank test was used for pair comparison (T1-T0). RESULTS: 26 pts (mean age 13.3 ± 4, 16 males) were included. The mean PCDAI, ileal SES-CD, CRP, ESR, BWT and disease extension values significantly decreased at T1 (table). Increased bowel wall vascularity was present in 80% of pts at T0 and in 24% at T1 (p<0.0001). In pts with complete and partial MH the extension of disease and themean BWT at US were significantly reduced at T1 (p<0.02); in pts without endoscopic response the US parameters didn't change significantly, despite clinical response. Presence of strictures and BWS didn't modify during therapy in any group. CONCLUSIONS: Biologics are effective in inducing clinical and laboratory remission and in achieving MH in pediatric CD. Transmural inflammation significantly improves during therapy, however when a substantial bowel damage (stricture) is present, the effect on TH might be poorer. Further studies are needed to evaluate the impact of TH on the long term outcome of CD. CLINICAL, ENDOSCOPIC AND US DATA AT T0 AND T1

880 Accuracy of Small Intestine Contrast Ultrasonography Compared to Magnetic Resonance Enterography in Characterizing Lesions in Patients With Crohn's Disease

880 Accuracy of Small Intestine Contrast Ultrasonography Compared to Magnetic Resonance Enterography in Characterizing Lesions in Patients With Crohn's Disease

P288 Accuracy of small intestine contrast ultrasonography compared to magnetic resonance enterography in characterizing lesions in patients with Crohn's disease

P288 Accuracy of small intestine contrast ultrasonography compared to magnetic resonance enterography in characterizing lesions in patients with Crohn's disease

Su1197 Recurrence and Long Term Evolution of Small Bowel (SB) Lesions After Curative Ileo-Colon Resection in Crohn's Disease (CD) Patients: A Prospective Follow-up Study

Previous radiological and endoscopic studies limiting their assessment to luminal alterations and/or upper GI and terminal ileum, and performed at patients or investigators' discretion could not provide a systematic prospective evolution of long-term CD SB lesions .Small intestine contrast ultrasonography (SICUS) is as accurate as (a) endoscopy to assess in operated patients the presence and severity of CD recurrence (1) and (b) surgery to assess the presence and extension of SB CD lesions (2). Aim. To assess, by means of SICUS in CD patients submitted to curative ileo-colonic resection and treated with immunosuppressive or biological therapy, the onset and long-term evolution of SB CD lesions in comparison to no, or mesalazine, therapy (not treated patients). Subjects and Methods. Follow-up (FU) visits and SICUS were carried out 6-12 monthly for 65±35.3 months in 60 operated patients (M 36, age at diagnosis 34.5±14 yrs); non treated patients 36/60. SICUS was performed after the ingestion of 375 ml of macrogol contrast solution as previously described (1). Results. Neo-terminal ileal recurrent lesions occurred in 48/60 (80%) patients at 20±21.8 months after surgery. No recurrence was detected in 9/36 of non treated patients (FU 54±38.5 months, range 12-120). Non-treated and treated patients did not differ in terms of median age at diagnosis (33 vs 31.5 yrs), extension of ileo-colonic resection (40 vs 25.5 cm) and time interval between surgery and first visit (6 vs 6.5 months). Median length of FU was longer in treated vs not-treated patients (69 vs 42 months, p=0.03). In not-treated patients recurrent lesions occurred in 16/27 after ≤ 12 months with a mean extension of 8.3±9.4 cm (last FU extension 12±10.4 cm), in 3/27 after ≤ 24 months with a mean extension of 19.8±19.8 cm (last FU extension 28±33 cm), in 1/27 after ≤ 36 months with an extension of 4 cm (last FU extension 4 cm), in 2/27 after ≤ 48 months with a mean extension of 4.8±2 cm (last FU extension 10.5±6.5 cm) and in 5/27 after . 48 months with a mean extension of 2.3±2.5 cm (last FU extension 4.5±2.3 cm). In treated patients recurrent lesions occurred in 15/21 after ≤ 12 months with a mean extension of 9±7 cm (last FU extension 8.5±9.5 cm), in 1/21 after ≤ 24 months with a extension of 10 cm (last FU extension 0.5 cm), in 2/21 after ≤ 36 months with a mean extension of 6.5±0.7 cm (last FU extension 18±7 cm), in 3/21 after ≤ 48 months with a mean extension of 1.4±1.3 cm (last FU extension 4.2±6.8 cm). Conclusions. SB CD recurrence occurred in 80% of the operated patients, more than 50% within the first year. An early recurrence of CD lesions appears to be associated with a greater extension compared to a later recurrence and immunosuppressive and biological therapies appear to delay the evolution of CD SB lesions. 1) Pallotta N et al BMC gastroenterology 2010;2) Pallotta N et al IBD 2012

Su1120 Impact of Small Intestine Contrast Ultrasonography in the Management of Crohn's Disease Patients

Su1120 Impact of Small Intestine Contrast Ultrasonography in the Management of Crohn's Disease Patients