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

Abstract

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.

Real-life chromoendoscopy for neoplasia detection and characterisation in long-standing IBD

“…Furthermore, for optimal management of these patients, it is recommended to remove all dysplastic lesions en bloc and take biopsies from surrounding mucosa to rule out ‘invisible’ dysplasia. Because of chronic inflammation, endoscopic management of dysplasia is associated to a higher rate of complications 33. Consequently, a better prediction of histology in real time would allow to increase the efficiency of surveillance endoscopy.…”

Are random biopsies still useful for the detection of neoplasia in patients with IBD undergoing surveillance colonoscopy with chromoendoscopy?

“…As recommended,1 8 17 the flat mucosa surrounding suspicious lesion was biopsied to assess whether there was any dysplasia in the surrounding mucosa. We distinguished in two separate jars the targeted biopsies or the resected lesion and the biopsies around the lesion.…”

Integrating omics for a better understanding of Inflammatory Bowel Disease: a step towards personalized medicine

“…Until recently, the diagnosis of IBD seemed straightforward, as it mainly required the presence of a chronic inflammation in the GI tract with the exclusion of other causes of inflammation due to an infectious disease, vasculitides or others [22]. The current diagnostic method consists of a combination of a detailed history assessment, physical and laboratory examination, esophagogastroduodenoscopy, ileo-colonoscopy combined with histology, and imaging of the small bowel using video capsule endoscopy or enteroscopy [23][24][25]. Mucosal biopsies often show a characteristic appearance of UC or CD [26][27][28].…”