Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED–ECCO consensus

Abstract

Institutions on behalf of the World Organisation of Digestive Endoscopy (OMED) and the European Crohn's and Colitis Organisation (ECCO)

Interventional balloon-enteroscopy

“…30 Crohn's disease is a chronic relapsing inflammatory disease of the intestinal tract and involvement of the small bowel may cause significant morbidity. 5 Balloon-enteroscopy is helpful to treat symptomatic small bowel strictures in Crohn's disease and in anastomotic strictures. 31,32 In Crohn's disease, inflammatory activity of the stenotic small bowel segment should endoscopically be excluded or accordingly treated with immunomodulators.…”

“…BE is a generic term for endoluminal examination of the small bowel by any endoscopic technique that includes balloon-assisted progression and is generally included in the definition of device-assisted enteroscopy, that comprise besides BE also overtube-assisted enteroscopy or use of stiffening devices. 5 BE complements small bowel imaging methods such as capsule endoscopy (CE), abdominal ultrasonography, and cross sectional imaging such as magnetic resonance imaging (MRI) and computed tomography (CT). Thereby, only BE offers interventional options or to take biopsies for histopathological investigations.…”

Blue mode does not offer any benefit over white light when calculating Lewis score in small-bowel capsule endoscopy

“…It has already showed to be a superior-to most existing radiological techniques-diagnostic tool in the in-vestigation of obscure gastrointestinal bleeding (OGIB), although its role in Crohn's (CD) is less clear [1] . Assessment of the full length of the small-intestine is often required not only to evaluate patients with suspected, but also those with established CD [2,3] . However, as the diagnosis of CD remains a clinical one -based on the combination of clinical, radiologic, endoscopic, and histologic findings-, caution is advised in using findings on SBCE as the primary means of making a diagnosis of small-small CD [3] .…”

Capsule endoscopy in inflammatory bowel disease type unclassified and indeterminate colitis serologically negative

“…However, in clinical practice routine evaluation of the small bowel by CE in asymptomatic patients is not indicated and, therefore, CE may be most clinically useful in a setting in which UC is refractory to medical treatment, or when presenting atypical clinical features, as well as in the case of previous colectomy. 21 Approximately 10% of patients with an initial diagnosis of UC will be reclassified as having either CD or IBDU at follow-up. 21 In 1 retrospective study, 19 patients out of 120 (16%), with an established diagnosis of UC and atypical symptoms (10%), or with medically refractory disease (9%), or with prior colectomy for UC and new intestinal complaints (33%), or those with IBDU (17%), could be reclassified as having CD based on the presence of typical small-bowel ulcerations (defined as the presence of 3 or more ulcerations) seen at CE.…”

“…21 Approximately 10% of patients with an initial diagnosis of UC will be reclassified as having either CD or IBDU at follow-up. 21 In 1 retrospective study, 19 patients out of 120 (16%), with an established diagnosis of UC and atypical symptoms (10%), or with medically refractory disease (9%), or with prior colectomy for UC and new intestinal complaints (33%), or those with IBDU (17%), could be reclassified as having CD based on the presence of typical small-bowel ulcerations (defined as the presence of 3 or more ulcerations) seen at CE. 8 In the setting of IBDU/IC, several studies on the benefit of CE for its evaluation have been published.…”