{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:44:47Z","timestamp":1787067887903,"version":"build-2736575974"},"reference-count":58,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,9,28]],"date-time":"2025-09-28T00:00:00Z","timestamp":1759017600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Perianal Crohn\u2019s disease (pCD) is one of the most disabling complications of inflammatory bowel disease, characterized by fistulas and abscesses that demand precise imaging for diagnosis, treatment planning, and follow-up. Magnetic resonance imaging (MRI) is considered the reference standard, but endoanal ultrasound (EAUS) with high-frequency 360\u00b0 probes provide a readily available, cost-effective, and repeatable alternative. Methods: We performed a narrative review of the literature, evaluating studies on the EAUS technique, diagnostic applications, distinguishing features of Crohn\u2019s-related fistulas, and comparative analyses with MRI. Consensus documents and structured reporting initiatives were also included. Results: EAUS provides high-resolution visualization of the anal sphincter complex and intersphincteric space, enabling the reliable detection of fistulas and abscesses. Characteristic features such as tract width &gt; 4 mm, bifurcation, hyperechoic debris, the Crohn\u2019s Ultrasound Fistula Sign (CUFS), and the rosary sign assist in differentiating Crohn\u2019s from cryptoglandular fistulas. EAUS is well-suited for serial monitoring, perioperative seton guidance, and therapeutic decision-making. Emerging tools such as Doppler and shear wave elastography provide additional information on activity and fibrosis. MRI remains indispensable for supralevator disease, deep pelvic sepsis, and standardized activity indices. Comparative studies indicate similar sensitivity for simple fistulas, with MRI superior in complex cases; combining both modalities maximizes accuracy. Conclusions: EAUS is a practical and repeatable imaging tool that complements MRI in the multidisciplinary management of perianal Crohn\u2019s disease. Advances such as 3D imaging, contrast enhancement, and elastography may enable validated activity scoring\u2014for example, a future PEACE (Perianal Endosonographic Activity in Chron\u2019s Evaluation) Index\u2014further strengthening its role in longitudinal care.<\/jats:p>","DOI":"10.3390\/jcm14196867","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:12:23Z","timestamp":1759223543000},"page":"6867","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Endoanal Ultrasound in Perianal Crohn\u2019s Disease"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6710-5933","authenticated-orcid":false,"given":"Mario","family":"Pagano","sequence":"first","affiliation":[{"name":"Proctology and Pelvic Floor Surgery Unit, Ospedale Isola Tiberina\u2014Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1415-621X","authenticated-orcid":false,"given":"Francesco","family":"Litta","sequence":"additional","affiliation":[{"name":"Proctology and Pelvic Floor Surgery Unit, Ospedale Isola Tiberina\u2014Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Parello","sequence":"additional","affiliation":[{"name":"Proctology and Pelvic Floor Surgery Unit, Ospedale Isola Tiberina\u2014Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8384-5081","authenticated-orcid":false,"given":"Angelo Alessandro","family":"Marra","sequence":"additional","affiliation":[{"name":"Proctology and Pelvic Floor Surgery Unit, Ospedale Isola Tiberina\u2014Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Campenn\u00ec","sequence":"additional","affiliation":[{"name":"Proctology and Pelvic Floor Surgery Unit, Ospedale Isola Tiberina\u2014Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0556-0037","authenticated-orcid":false,"given":"Carlo","family":"Ratto","sequence":"additional","affiliation":[{"name":"Proctology and Pelvic Floor Surgery Unit, Ospedale Isola Tiberina\u2014Gemelli Isola, 00186 Rome, Italy"},{"name":"Department of Medicine and Translational Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1477","DOI":"10.1093\/ibd\/izab287","article-title":"Epidemiology and Natural History of Perianal Crohn\u2019s Disease: A Systematic Review and Meta-Analysis of Population-Based Cohorts","volume":"28","author":"Tsai","year":"2022","journal-title":"Inflamm. 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