Pal P, Kata P, Mateen MA, Ankam VK, Jha DL, Gupta R, Tandan M, Duvvur NR. Multimodality ultrasound in Crohn’s disease strictures. World J Gastrointest Pharmacol Ther 2026; 17(1): 111833 [DOI: 10.4292/wjgpt.v17.i1.111833]
Corresponding Author of This Article
Partha Pal, MD, FASGE, MRCP, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Red Rose Cafe Lane, Sangeet Nagar, Somajiguda, Hyderabad 500082, Telangāna, India. partha0123456789@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Pharmacol Ther. Mar 5, 2026; 17(1): 111833 Published online Mar 5, 2026. doi: 10.4292/wjgpt.v17.i1.111833
Multimodality ultrasound in Crohn’s disease strictures
Partha Pal, Priyaranjan Kata, Mohammad Abdul Mateen, Vamsi Krishna Ankam, Deepak Lalan Jha, Rajesh Gupta, Manu Tandan, Nageshwar Reddy Duvvur
Partha Pal, Vamsi Krishna Ankam, Deepak Lalan Jha, Rajesh Gupta, Manu Tandan, Nageshwar Reddy Duvvur, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, Telangāna, India
Priyaranjan Kata, Department of Medicine, MedStar St. Mary’s Hospital, Leonardtown, MD 20650, United States
Mohammad Abdul Mateen, Diagnostic Radiology and Imaging, Asian Institute of Gastroenterology, Hyderabad 500082, Telangāna, India
Co-first authors: Partha Pal and Priyaranjan Kata.
Author contributions: Pal P and Kata P contributed equally to this manuscript and are co-first authors; Pal P, Ankam VK, Gupta R, and Tandan M contributed to the literature search; Kata P and Jha DK contributed to critical manuscript review; Pal P conceptualized the work, wrote the first draft, and prepared the final manuscript; Kata P performed the first screening; Mateen MA resolved disagreements after screening; Ankam VK contributed to the manuscript review; Jha DK proofread the manuscript; Gupta R, Mateen MA, Tandan M, and Reddy DN contributed to the writing, provided intellectual input, and critically revised the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Partha Pal, MD, FASGE, MRCP, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Red Rose Cafe Lane, Sangeet Nagar, Somajiguda, Hyderabad 500082, Telangāna, India. partha0123456789@gmail.com
Received: July 11, 2025 Revised: August 21, 2025 Accepted: January 6, 2026 Published online: March 5, 2026 Processing time: 216 Days and 4 Hours
Abstract
BACKGROUND
Stricture formation in Crohn’s disease (CD) poses a significant clinical challenge, often requiring differentiation between inflammatory and fibrotic components to guide appropriate therapy.
AIM
To evaluate the utility of multimodal intestinal ultrasound - including small intestine contrast ultrasonography (SICUS), contrast-enhanced ultrasound (CEUS), and ultrasound-based elastography - in detecting and characterizing CD-related small bowel strictures.
METHODS
A review was conducted in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A comprehensive search of PubMed and EMBASE databases from inception to June 2025 yielded 697 records, respectively. After screening and full-text assessment, 43 studies were included. Eligible studies reported on the use of SICUS, CEUS, and elastography for detecting or phenotyping CD strictures, with comparisons to cross-sectional imaging, histopathology, endoscopy, or surgical findings.
RESULTS
Across heterogeneous study designs, SICUS demonstrated high sensitivity for stricture detection (typically approximately 88%-98%) with specificity that varied by cohort and criteria. Common thresholds included bowel wall thickness > 3 mm, luminal narrowing < 1 cm, and/or prestenotic dilation > 2.5 cm. CEUS effectively distinguished fibrotic from inflammatory strictures using time-intensity curve metrics: Fibrotic strictures showed reduced peak enhancement (e.g., 25 dB vs 38 dB), and lower perfusion area under the curve (AUC) values (e.g., 570 intensity time units vs 1168 intensity time units), reflecting diminished vascularity. Cutoffs such as peak enhancement < 30 dB and AUC < 700 units were associated with fibrosis. Elastography - particularly shear wave elastography achieved AUCs of 0.88-0.91 for fibrosis detection using cutoffs of 2.5-2.9 m/second (sensitivity 80%-88%, specificity 85%-100%). Strain ratio thresholds between 2.2 and 3.0 also differentiated fibrotic from inflammatory lesions with diagnostic AUCs up to 0.91. Among elastography modalities, shear wave elastography consistently outperformed strain elastography and acoustic radiation force impulse in accuracy and reproducibility.
CONCLUSION
Multimodal intestinal ultrasound - including SICUS, CEUS, and elastography - offers a comprehensive, radiation-free framework to detect, localize, and phenotype CD strictures. While performance is promising, variability in thresholds and reference standards limits generalizability. Standardized acquisition, predefined cut-offs, and multicenter validation are priorities before widespread adoption in treatment algorithms.
Core Tip: Multimodal intestinal ultrasound - including contrast-enhanced ultrasound, small intestine contrast ultrasonography, and ultrasound-based elastography - offers a noninvasive, radiation-free, and accurate approach to characterize Crohn’s disease strictures. Small intestine contrast ultrasonography reliably detects strictures and disease extent with performance comparable to cross-sectional imaging. Contrast-enhanced ultrasound perfusion parameters such as peak enhancement and AUC help differentiate inflammation from fibrosis, especially when combined with elastography. Shear wave elastography provides quantitative stiffness assessment, with velocities > 2.5 m/second indicating fibrosis. These tools support precise stricture phenotyping and may guide tailored therapy and surgical decision-making.
