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Review
. 2018;31(2):e1374.
doi: 10.1590/0102-672020180001e1374. Epub 2018 Jul 2.

THE IMPORTANCE OF COLONOSCOPY IN INFLAMMATORY BOWEL DISEASES

[Article in English, Portuguese]
Márcio Alexandre Terra Passos  1 , Fernanda Correa Chaves  1 , Nilson Chaves-Junior  1
Affiliations
Review

THE IMPORTANCE OF COLONOSCOPY IN INFLAMMATORY BOWEL DISEASES

[Article in English, Portuguese]
Márcio Alexandre Terra Passos et al. Arq Bras Cir Dig. 2018.

Abstract
in English, Portuguese

Introduction: Endoscopic evaluation, particularly the macroscopic mucosal and histological results of ileocolic biopsies, is essential for the management of inflammatory bowel disease. Endoscopic appearance is not always sufficient to differentiate Crohn's disease and ulcerative colitis, but there are some characteristics that favor one or another diagnosis. Both diseases have an increased incidence of colorectal carcinoma; so, surveillance colonoscopy is important for detecting early neoplastic lesions.

Objective: To update the importance of endoscopy in the evaluation, diagnosis and prognosis of inflammatory bowel disease.

Method: Search was done in the scientific literature of the TRIP database, chosen from clinical questions (PICO) with the following descriptors: "inflammatory bowel disease", "endoscopy/colonoscopy", "Crohn's disease", "ulcerative colitis" and "diagnosis/treatment".

Results: Endoscopic investigation in patients with chronic colitis is quite accurate for the differential diagnosis between ulcerative colitis and Crohn's disease. Endoscopy is indicated for ulcerative colitis during severe crisis due to its prognostic value. Another accepted indication for endoscopy in inflammatory bowel disease is its use in the screening for dysplastic lesion.

Conclusion: Ileocolonoscopy allows an accurate diagnosis of Crohn's disease or ulcerative colitis in up to 90% of cases. The healing of the mucosa assessed by endoscopy after treatments despite not being consensus is still the gold-standard in the evaluation of remission of the disease. Colonoscopy is essential for long-term cancer surveillance and in the future the implementation of Confocal Laser Endomicroscopy seems to be very promising in assessing the initial dysplasia.

A avaliação endoscópica, em particular da macroscopia das mucosas e resultados histológicos de biópsias ileocolônicas, é essencial para o manuseio da doença inflamatória intestinal. A aparência endoscópica nem sempre é suficiente para diferenciar doença de Crohn e colite ulcerativa, porém existem algumas características que favorecem um ou outro diagnóstico. Ambas as doenças apresentam um aumento de incidência de carcinoma colorretal, assim, a colonoscopia de vigilância é importante para detectar lesões neoplásicas iniciais.

Revisar o papel da endoscopia na avaliação, diagnóstico e prognóstico de doença inflamatória intestinal.

Foram pesquisados artigos científicos do banco de dados TRIP, escolhidos a partir de questões clínicas (PICO) com os seguintes descritores: “doença inflamatória intestinal”, “endoscopia/colonoscopia”, “doença de Crohn/colite ulcerativa” e “diagnóstico/tratamento”.

A investigação endoscópica em pacientes com colite crônica é bastante precisa para o diagnóstico diferencial entre colite ulcerativa e doença de Crohn. Ela é indicada na colite ulcerativa durante as crises graves de doença, por seu valor prognóstico. Outra indicação aceita na doença inflamatória intestinal é a sua utilização no rastreio da lesão displásica.

A Ileocolonoscopia permite diagnóstico preciso da doença de Crohn ou colite ulcerativa em até cerca de 90% dos casos. A cicatrização da mucosa avaliado por endoscopia após tratamentos, apesar de não ser consenso, ainda é o padrão-ouro na avaliação da remissão da doença.Colonoscopia é essencial para a vigilância do câncer em longo prazo. Futuramente a realização de Confocal Laser Endomicroscopy parece ser promissora na avaliação da displasia inicial.

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Conflict of interest statement

Conflict of interest: none

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