Enteroscopy in children and adults with inflammatory bowel disease

Abstract

Inflammatory bowel disease (IBD) includes Crohn’s disease (CD), ulcerative colitis and unclassified entities. CD commonly involves the terminal ileum and colon but at the time of diagnosis it can be confined to the small bowel (SB) in about 30% of the patients, especially in the young ones. Management of isolated SB-CD can be challenging and objective evaluation of the SB mucosa is essential in differentiating CD from other enteropathies to achieve therapeutic decisions and to plan the follow-up. The introduction of cross-sectional imaging techniques and capsule endoscopy (CE) have significantly expanded the ability to diagnose SB diseases providing a non-invasive test for the visualization of the entire SB mucosa. The main CE limitations are the low specificity, the lack of therapeutic capabilities and the impossibility to take biopsies. Device assisted enteroscopy (DAE) enables histological confirmation when traditional endoscopy, capsule endoscopy and cross-sectional imaging are inconclusive and also allows therapeutic interventions such as balloon stricture dilation, intralesional steroid injection, capsule retrieval and more recently stent insertion. In the current review we will discuss technical aspect, indications and safety profile of DAE in children and adults with IBD.

Challenges in Crohn’s Disease Management after Gastrointestinal Cancer Diagnosis

“…The upper endoscopy allows the exploration of the first tract of the small bowel and may be useful in detecting duodenal or proximal jejunal tumors. Enteroscopy allows the visualization of the all-small bowel surface with a push or double-balloon technique, giving also the opportunity of sample collection and therapeutic procedures [ 91 ]. This technique could be useful in patients with suspicious small bowel stricture in order to perform a differential diagnosis between inflammatory stricture and small bowel cancer.…”

Congenital enterocolic fistula discovered by jejunoscopy

“…Hence this procedure is challenging in young children under 14 kg weight due to a smaller abdominal cavity, thinner intestinal walls, anatomically narrow lumen and acute angulations of proximal bowel flexures. 5,6 Upper gastrointestinal contrast series is dependant on the pressure gradient between the jejunum and colon and the position of the fistula. It may fail to pick up the diagnosis in 30e70% cases.…”

Association between autism spectrum disorder and inflammatory bowel disease: A systematic review and meta‐analysis

“…While esophagogastroduodenoscopy and colonoscopy and consequent pathology may confirm diagnosis of IBD in suspected patients, these tests are often difficult for children (Henderson et al, 2014). Intestinal ultrasound to detect increased bowel wall thickening and other signs of IBD is an alternative non‐invasive method of diagnosis with relatively high sensitivity and specificity (Dilillo et al, 2019; Nardo et al, 2020). Clinicians should acknowledge the high possibility of IBD in patients with ASD who report GI symptoms, and future guidelines for early screening of IBD with non‐invasive tests and vigilant monitoring of GI symptoms in patients with ASD must be established, which can serve as important strategies to improve prognosis and quality of life for patients with ASD.…”