The role of small bowel endoscopy in small bowel Crohn's disease: when and how?

Abstract

Endoscopy has a crucial role in the diagnosis, management, and surveillance of inflammatory bowel disease (IBD). It contributes in supporting the diagnosis of IBD with the clinical history, physical examination, laboratory findings, and targeted biopsies. Furthermore, endoscopy has a significant role in assessing disease activity and distribution in treatment efficacy evaluation, post-surgical recurrence risk, and cancer surveillance in patients with long-lasting illness. Endoscopy also provides therapeutic potential for the treatment of IBD, especially with stricture dilatation and treatment of bleeding. Small bowel (SB) endoscopy (capsule endoscopy and device-assisted enteroscopy) and cross-sectional radiologic imaging (computed tomography enterography and magnetic resonance enterography) have become important diagnostic options to diagnose and treat patients with SB Crohn's disease. We reviewed the present role of SB endoscopy in patients with SB Crohn's disease.

Keywords: Balloon-assisted enteroscopy; Capsule endoscopy; Crohn disease.

Fig. 1. Enteroscopic findings of small bowel CD. Enteroscopic images of small bowel CD show erosions (A), a longitudinal ulcer (B), and an eccentric ulcer with stricture (C). Enteroscopy is helpful to find a fistulous tract of small intestine through a selective radiography (D).

Fig. 2. Therapeutic endoscopy of small bowel CD. Enteroscpic image shows an exposed vessel of deep penetrating ulcers in the patients with small bowel CD presenting massive lower gastrointestinal bleeding (A). Enteroscopy provides hemoclipping on the pulsating vessel (B). There is a severe stricture in the patients with small bowel CD (C). Enteroscopy provides balloon dilation on this short stricture (D).