Diagnostic performance and feasibility of bowel elastography in the pediatric population: a systematic review

This systematic review evaluates the diagnostic performance and feasibility of bowel elastography in the pediatric population (≤18 years). Ultrasound elastography (strain and shear wave) and MR elastography quantify bowel-wall stiffness and may non-invasively characterize inflammatory versus fibrotic change, but existing syntheses are limited to adults or to Crohn disease. We will systematically review elastography of the bowel wall and appendix across pediatric pathologies — inflammatory bowel disease, celiac disease, acute appendicitis and intussusception — and in healthy children (normative/feasibility studies). PubMed, Embase, Scopus, Web of Science and Cochrane CENTRAL will be searched from inception, supplemented by hand-searching of reference lists. Two reviewers will independently screen, extract data, and assess risk of bias (QUADAS-2; JBI for case series). Primary outcomes are diagnostic accuracy (sensitivity, specificity, AUC, correlation with reference standards) and normative values with feasibility/reproducibility. Evidence will be synthesized narratively (SWiM), with quantitative meta-analysis attempted only where studies are sufficiently homogeneous in modality, unit and outcome. Certainty will be graded with GRADE. Reporting follows PRISMA 2020 and PRISMA-DTA.