Investigation of the small bowel has been traditionally a challenge for pediatric gastroenterologists due to its location, anatomical tortuosity, and invasiveness of the available techniques. Recently, there has been a remarkable improvement in imaging and endoscopic tools aimed at exploring successfully the small intestine in inflammatory bowel disease. The former are represented by ultrasonography (either alone or with administration of oral contrast agents) and by magnetic resonance: both have provided accurate methods to detect structural bowel changes, diminishing patient discomfort and precluding radiation hazard. The use of traditional radiologic techniques such as fluoroscopy have been markedly reduced due to radiation exposure and inability to depict transmural inflammation or extraluminal complications. Among the novel endoscopic tools, capsule endoscopy and balloon‐assisted enteroscopy have tremendously opened new diagnostic and therapeutic perspectives, by allowing the direct visualization of small intestinal mucosa and, through enteroscopy, histological diagnosis as well as therapeutic interventions such as stricture dilation and bleeding treatment. These endoscopic techniques should always be preceded by imaging of the intestine in order to identify strictures. This review describes the most recent progress with the employment of novel imaging and endoscopic methodologies for investigating the small bowel in children with suspected or established Crohn's disease. (Inflamm Bowel Dis 2012;)
1Department od Pediatrics and Infantile Neuropsychiatry, Pediatric Gastroenterology and Liver Unit, University Hospital Umberto I, Rome, Italy
2Department of Radiology, Sapienza University of Rome, University Hospital Umberto I, Rome, Italy
*Reprints: Department of Pediatrics and Infantile Neuropsychiatry, Head, Pediatric Gastroenterology and Liver Unit, Director, Sapienza University of Rome, Viale Regina Elena 324, 00161 Rome, Italy
Received 10 December 2011; Accepted 28 December 2011
Published online 24 January 2012 in Wiley Online Library (wileyonlinelibrary.com).
†The first two authors contributed equally to this study.