Endoscopic therapy in inflammatory bowel diseases (with videos)

Paine, Elizabeth; Shen, Bo

doi:10.1016/j.gie.2013.08.023

Cited by 62 publications

(47 citation statements)

References 121 publications

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“…The main application is endoscopic stricture therapy, which is exemplified by EBD of stricture. 49 A systemic review by Hassan et al 15 evaluating the utility of DBE for strictures in patients with CD, including patients with previous surgery, showed that short strictures (,4 cm) can be successfully treated with TTS balloon dilation. There are emerging data from case series pertaining to the role of BAE for diagnosis of CD and stricture therapy.…”

Section: Endoscopy After Bypass Surgery For CDmentioning

confidence: 99%

“…For pinhole and angulated strictures that cannot be safely traversed with a gastroscope or pediatric colonoscope, antegrade TTS balloon dilation with guidewire exchange technique can be performed. 49,56 Balloon dilation can be performed for strictures at the previous loop ileostomy site, pouch inlet, and anastomosis in patients with IPAA.…”

Section: Endoscopy After Bypass Surgery For CDmentioning

confidence: 99%

“…7B). 49 In cases of retained capsule endoscope, DBE can be used to extract the capsule, thus averting the need for surgical intervention. 60 Patients with Kock pouch are at risk for having foreign body or bezoar, which are amenable to endoscopic retrieval therapy in most cases.…”

Section: Fecal Bezoar and Foreign Body Removalmentioning

confidence: 99%

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Endoscopic Evaluation of Surgically Altered Bowel in Patients With Inflammatory Bowel Diseases

Shen¹

2018

Interventional Inflammatory Bowel Disease: Endoscopic Management and Treatment of Complications

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Patients with inflammatory bowel diseases often undergo surgical procedures for medically refractory disease or colitis associated dysplasia.Endoscopic evaluation of the surgically altered bowel is often needed to assess for disease recurrence, its severity, and for therapy. It is important to obtain and review the operative report and abdominal imaging before performing the endoscopy. Diagnostic and therapeutic endoscopy can be safely performed in most patients with inflammatory bowel disease with altered bowel anatomy under conscious sedation without fluoroscopy. Carefully planned stricture therapy with balloon dilation or needle knife stricturotomy can be performed for simple, short, and fibrotic strictures. A multidisciplinary approach involving a team of endoscopist, endoscopy nurse, colorectal surgeon, gastrointestinal pathologist, and gastrointestinal radiologist is important for a safe and effective endoscopy. We attempt to review the aspects that need consideration before the endoscopy, the technique of endoscopy, and briefly the therapies that can be performed during endoscopy of the bowel through an ileostomy, a colostomy, in the diverted large bowel or ileal pouch, and small bowel after stricturoplasty and bowel bypass surgery in patients with inflammatory bowel diseases.

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Section: Endoscopy After Bypass Surgery For CDmentioning

confidence: 99%

Section: Endoscopy After Bypass Surgery For CDmentioning

confidence: 99%

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Endoscopic Evaluation of Surgically Altered Bowel in Patients With Inflammatory Bowel Diseases

Shen¹

2018

Interventional Inflammatory Bowel Disease: Endoscopic Management and Treatment of Complications

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“…56,57 These indications have been extrapolated to stricturing CD. 58 We use needle knife under the guidance of a Doppler ultrasound probe to identify a relatively avascular area, suitable for incision, with acceptable safety. 59 This is more effective than EBD in experienced hands, although further evidence is needed.…”

Section: Needle Knife Electro Incisionmentioning

confidence: 99%

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

Tharian

George

Navaneethan

2016

Inflammatory Bowel Diseases

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The role of endoscopy in inflammatory bowel disease (IBD) has grown over the last decade in both diagnostic and therapeutic realms. It aids in the initial diagnosis of the disease and also in the assessment of the extent and severity of disease. IBD is associated with development of multiple complications such as strictures, fistulae, and colon cancers. Endoscopy plays a pivotal role in the diagnosis of colon cancer in patients with IBD through incorporation of chromoendoscopy for surveillance. In addition, endoscopic resection with surveillance is recommended in the management of polypoid dysplastic lesions without flat dysplasia. IBD-associated benign strictures with obstructive symptoms amenable to endoscopic intervention can be managed with endoscopic balloon dilation both in the colon and small intestine. In addition, endoscopy plays a major role in assessing the neoterminal ileum after surgery to risk-stratify patients after ileocolonic resection and assessment of a patient with ileoanal pouch anastomosis surgery and management of postsurgical complications. Our article summarizes the current evidence in the role of endoscopy in the diagnosis and management of complications of IBD.

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“…Van Assche et al [24] described a short anastomotic stricture (length <5 cm) as an ideal stricture for dilation. Paine and Shen [25] proposed a classification system for IBD strictures based on etiology, number, degree, length, location and associated condition (e.g. fibrosis, edema, proximal dilatation, ulceration, fistula with or without abscess, angulation and prior stricturoplasty), but this classification has not been validated.…”

Section: Stricture- and Patient-specific Features Influencing The Promentioning

confidence: 99%

Endoscopic and Medical Management of Fibrostenotic Crohn's Disease

Thienpont

Assche²

2014

Dig Dis

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Crohn's disease (CD) is a disease characterized by acute inflammation at diagnosis which evolves toward a more fistulizing and fibrostenotic disease phenotype over time. This leads to a high risk of bowel resections and ultimately short bowel with diarrhea and malabsorption, which represents a major part of the burden inflicted by CD. Bowel-conserving endoscopic and surgical procedures have therefore been developed. Specific antifibrotic medical therapies are currently lacking. Through-the-scope endoscopic balloon dilation has been described in several cohorts as an alternative to surgical resection or stricturoplasty in selected patients. Efficacy of endoscopic dilation is high, with an immediate success rate of 78% (between 73 and 100%), defined as the ability to pass with the scope through the stricture. However, symptomatic recurrence is frequent, with need for new dilatation in 41% and need for surgery in 42%, with a mean interval of 15 months. Adjunctive techniques such as local steroid or anti-TNF injections or stenting have not been conclusively proven to be of added benefit. We usually reserve endoscopic dilation for patients with short strictures (<5 cm) and nonpenetrating disease, preferably at the ileocolonic anastomosis. Similar to other interventions in endoscopy, endoscopic dilation has an intrinsic risk of complications which can be estimated at 2%. Balloon size and patient selection can serve to increase safety.

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Endoscopic therapy in inflammatory bowel diseases (with videos)

Cited by 62 publications

References 121 publications

Endoscopic Evaluation of Surgically Altered Bowel in Patients With Inflammatory Bowel Diseases

Endoscopic Evaluation of Surgically Altered Bowel in Patients With Inflammatory Bowel Diseases

Endoscopy in the Diagnosis and Management of Complications of Inflammatory Bowel Disease

Endoscopic and Medical Management of Fibrostenotic Crohn's Disease

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