P0418Role of intestinal ultrasound in the assessment of fibrosis in stricturing Crohn’s disease (CD): a retrospective study with histological correlation

Abstract Background Differentiating predominantly inflammatory from fibrotic strictures in Crohn’s disease (CD) is crucial for therapeutic decision-making but remains challenging in clinical practice. Intestinal ultrasound (IUS) is a non-invasive and widely available tool, yet the ultrasound parameters that best predict histological fibrosis are not well established. The aim of our study was to identify ultrasound, clinical, and laboratory parameters associated with the degree of histological fibrosis in patients with stricturing CD undergoing ileocolic resection. Methods We conducted a retrospective single-centre study including 37 patients with stricturing CD who underwent laparoscopic ileocolic resection (2013–2025). For each patient, clinical, laboratory and ultrasound data were collected, including bowel wall thickness, preservation of wall stratification, Limberg score, extra-intestinal findings (mesenteric fat, lymphnodes, fistulas/abscesses) and pre-stenotic dilatation. Fibrosis was assessed on surgical specimens using Chiorean and Higgins histological scores; the Higgins score was used for statistical analyses. Correlation analyses and multivariable models were performed. Results Perfect agreement was observed between Chiorean and Higgins histological scores (Cohen’s k = 1.0). The Limberg score showed a significant inverse correlation with fibrosis severity (r = –0.519; p = 0.001), indicating that lower vascularity on IUS is associated with a higher degree of fibrosis. Bowel wall thickness showed only a non-significant trend toward correlation with fibrosis. Other ultrasound features and serum biomarkers (CRP, faecal calprotectin, albumin, platelets) were not significantly associated with fibrosis grade. In multivariate analysis, a lower Limberg score emerged as the only independent predictor of more severe fibrosis. Conclusion The Limberg score appears to be an indirect ultrasound marker of intestinal fibrosis in stricturing CD, whereas common serum biomarkers do not discriminate fibrosis severity. Case expansion and the development of artificial intelligence models are ongoing to derive a more objective and reproducible ultrasound fibrosis score. References: 1. Kucharzik T, Taylor S, Allocca M, et al. ECCO-ESGAR-ESP-IBUS Guideline on Diagnostics and Monitoring of Patients with Inflammatory Bowel Disease: Part 1. J Crohns Colitis. 2025;19(7):jjaf106. doi:10.1093/ecco-jcc/jjaf106 2. Adamina M, Minozzi S, Warusavitarne J, et al. ECCO Guidelines on Therapeutics in Crohn’s Disease: Surgical Treatment. J Crohns Colitis. 2024;18(10):1556-1582. doi:10.1093/ecco-jcc/jjae089 3. Tavares de Sousa H, Magro F. How to Evaluate Fibrosis in IBD?. Diagnostics (Basel). 2023;13(13):2188. Published 2023 Jun 27. doi:10.3390/diagnostics13132188 Conflict of interest: Pardi, Veronica: No conflict of interest Ceccarelli, Linda: No conflict of interest Ricchiuti, Angelo: No conflict of interest Baiano Svizzero, Giovanni: No conflict of interest Fe’, Pietro: No conflict of interest Comparato, Chiara: No conflict of interest Di Rella, Ilaria: No conflict of interest Gargani, Alessia: No conflict of interest Lambiase, Christian: No conflict of interest Mumolo, Maria Gloria: No conflict of interest Neri, Carlo Maria: No conflict of interest de Bortoli, Nicola: No conflict of interest Bellini, Massimo: No conflict of interest Franceschi, Matteo: No conflict of interest Costa, Francesco: No conflict of interest