Elastography of the GI Tract.

Odd Helge Gilja, Prof., MD, PhD National Centre for Ultrasound in Gastroenterology Haukeland University Hospital, Bergen, and Department of Clinical Medicine, University of Bergen, Norway.

Elastography is a relative new technique that depicts the stiffness of tissue and is already used in clinical practice for several indications.

Guidelines and recommendations of the different techniques and clinical applications was published by EFSUMB. Elastography and strain imaging has also been suggested as a tool for assessing diseases of the gastrointestinal tract.
The bowel wall is a thin structure, which does not make it the ideal organ to be studied with elastography. However, pathology of the GI tract such as inflammation or tumour causes bowel wall thickening and often reduces motility and luminal contents in the affected area which may facilitate strain imaging. There is evidence for the use of elastography in endorectal ultrasonography, but the evidence for transabdominal elastography of the bowel is sparse. However, some recent studies suggest that it can be used to differentiate between fibrotic and inflammatory stenosis in Crohn’s disease. In patients with a stricture of the bowel and resultant bowel obstruction, it is important to determine if there is active inflammation at the site of stricture or if the obstructed segment is fibrotic. Using elastography, the active inflammatory components will be softer whereas the fibrotic stricture will appear stiffer. Accordingly, one may apply elastography to evaluate stiffness of the stenotic area, thus providing more clues to the fibrous content of the stricture. In conclusion, elastography may become a relevant clinical tool, but we need more studies to determine its usefulness in the management of patients with GI diseases.

References: 1. Bamber J, Cosgrove D, Dietrich CF, Fromageau J, Bojunga J, Calliada F, Cantisani V, Correas JM, D’Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Gilja OH,Havre RF,JenssenC,KlauserAS,Ohlinger R, Saftoiu A,SchaeferF, SporeaI,PiscagliaF. EFSUMBGuidelinesand Recommendations on the Clinical Use of Ultrasound Elastography. Part 1: Basic Principles and Technology. Ultraschall Med. 2013 Apr;34(2):169-84. http://dx.doi.org/10.1055/s-00331335205. Epub 2013 Apr 4. 2. Cosgrove D, Piscaglia F, Bamber J, Bojunga J, Correas JM, Gilja OH, Klauser AS, Sporea I, Calliada F, Cantisani V, D’Onofrio M, Drakonaki EE, Fink M, Friedrich-Rust M, Fromageau J, Havre RF, Jenssen C, Ohlinger R, Saftoiu A, Schaefer F, Dietrich CF. EFSUMBGuidelines and Recommendations on the Clinical Use of Ultrasound Elastography.