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.

Keywords: Crohn’s disease; Device assisted enteroscopy; Endoscopic balloon dilation; Enteroscopy; Inflammatory bowel disease; Small bowel disease.

Figure 1

Suggested algorithm in children with suspected inflammatory bowel disease (adapted by reference 6). GI: Gastrointestinal; MR: Magnetic resonance; SB: Small bowel.

Figure 2

Suggested algorithm in children with known inflammatory bowel disease (adapted by reference 6). GI: Gastrointestinal; MRI: Magnetic resonance imaging; SB: Small bowel; CE: Capsule endoscopy.