eprintid: 10203876 rev_number: 11 eprint_status: archive userid: 699 dir: disk0/10/20/38/76 datestamp: 2025-01-23 13:19:05 lastmod: 2025-05-07 06:10:09 status_changed: 2025-01-23 13:19:05 type: article metadata_visibility: show sword_depositor: 699 creators_name: Lu, Cathy creators_name: Rosentreter, Ryan creators_name: Parker, Claire E creators_name: Remillard, Julie creators_name: Wilson, Stephanie R creators_name: Baker, Mark E creators_name: Bhatnagar, Gauraang creators_name: Begun, Jakob creators_name: Bruining, David H creators_name: Bryant, Robert V creators_name: Christensen, Britt creators_name: Feagan, Brian G creators_name: Fletcher, Joel G creators_name: Gordon, Ilyssa creators_name: Henderson, Gaylyn creators_name: Jairath, Vipul creators_name: Knudsen, John creators_name: Kucharzik, Torsten creators_name: Lesack, Kyle creators_name: Maaser, Christian creators_name: Maconi, Giovanni creators_name: Novak, Kerri creators_name: Rimola, Jordi creators_name: Taylor, Stuart A creators_name: Wilkens, Rune creators_name: Rieder, Florian creators_name: Stenosis Therapy and Anti-Fibrotic Research (STAR) consortium, title: International expert guidance for defining and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound: a consensus statement ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: FI6 note: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions. abstract: BACKGROUND: Diagnostic imaging using CT enterography, magnetic resonance enterography, and intestinal ultrasound are important tools in evaluating stricturing Crohn's disease. Definitions of strictures have been developed for CT enterography and magnetic resonance enterography. However, expert recommendations for definitions and treatment response of strictures on intestinal ultrasound are not available. The aim of this study was to standardise definitions, diagnosis, and treatment response criteria in small bowel stricturing Crohn's disease on intestinal ultrasound. METHODS: Using modified RAND-University of California Los Angeles Appropriateness Method, a diverse expert panel of 13 gastroenterologists, seven radiologists, and two patient representatives was assembled. A total of 466 statements on definitions and response to therapy of stricturing Crohn's disease on intestinal ultrasound were generated from a systematic review and from expert opinion, with subsequent rating for appropriateness. Two rounds of voting with an interposed survey result discussion were performed. Statements were classified as inappropriate, uncertain, or appropriate based on the median panel rating and degree of disagreement. Appropriateness was rated using a nine-point Likert scale (1 being inappropriate, 9 being highly appropriate). FINDINGS: A naive or anastomotic small bowel Crohn's disease stricture on intestinal ultrasound is defined by the combination of bowel wall thickening, luminal narrowing, and pre-stenotic dilation. Bowel wall thickness is defined as being more than 3 mm. Luminal narrowing is defined as either a luminal diameter reduction of more than 50% in the narrowest area and relative to a normal adjacent bowel loop, or a luminal diameter of less than 1 cm. Pre-stenotic dilation is defined as more than 2·5 cm or an increase in bowel diameter relative to a normal adjacent bowel loop. Definitions for grading hyperaemia, inflammatory fat, wall stratification, intestinal ultrasound machine technical parameters, and image acquisition were also devised. Treatment response of strictures was defined as reduction in stricture length, bowel wall thickening, luminal narrowing, pre-stenotic dilation, and motility abnormalities. INTERPRETATION: To our knowledge, this is the first intestinal ultrasound appropriateness rating exercise conducted for defining, diagnosing, and measuring response to therapy in small bowel stricturing Crohn's disease and informs future clinical use and intestinal ultrasound index development for clinical trials. FUNDING: Leona M and Harry B Helmsley Charitable Trust. date: 2024-12 date_type: published publisher: Elsevier official_url: https://doi.org/10.1016/s2468-1253(24)00265-6 oa_status: green full_text_type: other language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2330329 doi: 10.1016/S2468-1253(24)00265-6 medium: Print-Electronic pii: S2468-1253(24)00265-6 lyricists_name: Taylor, Stuart lyricists_id: STAYL70 actors_name: Taylor, Stuart actors_id: STAYL70 actors_role: owner funding_acknowledgements: [Leona M and Harry B Helmsley Charitable Trust] full_text_status: public publication: The Lancet Gastroenterology and Hepatology volume: 9 number: 12 pagerange: 1101-1110 pages: 10 event_location: Netherlands issn: 2468-1253 citation: Lu, Cathy; Rosentreter, Ryan; Parker, Claire E; Remillard, Julie; Wilson, Stephanie R; Baker, Mark E; Bhatnagar, Gauraang; ... Stenosis Therapy and Anti-Fibrotic Research (STAR) consortium; + view all <#> Lu, Cathy; Rosentreter, Ryan; Parker, Claire E; Remillard, Julie; Wilson, Stephanie R; Baker, Mark E; Bhatnagar, Gauraang; Begun, Jakob; Bruining, David H; Bryant, Robert V; Christensen, Britt; Feagan, Brian G; Fletcher, Joel G; Gordon, Ilyssa; Henderson, Gaylyn; Jairath, Vipul; Knudsen, John; Kucharzik, Torsten; Lesack, Kyle; Maaser, Christian; Maconi, Giovanni; Novak, Kerri; Rimola, Jordi; Taylor, Stuart A; Wilkens, Rune; Rieder, Florian; Stenosis Therapy and Anti-Fibrotic Research (STAR) consortium; - view fewer <#> (2024) International expert guidance for defining and monitoring small bowel strictures in Crohn's disease on intestinal ultrasound: a consensus statement. The Lancet Gastroenterology and Hepatology , 9 (12) pp. 1101-1110. 10.1016/S2468-1253(24)00265-6 <https://doi.org/10.1016/S2468-1253%2824%2900265-6>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10203876/1/Taylor_International%20expert%20guidance%20for%20defining%20and%20monitoring%20small%20bowel%20strictures%20in%20Crohn.pdf