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Review
. 2021 May 28;27(20):2521-2530.
doi: 10.3748/wjg.v27.i20.2521.

Evolving role of endoscopy in inflammatory bowel disease: Going beyond diagnosis

Paulina Núñez F  1 , Noa Krugliak Cleveland  2 , Rodrigo Quera  1 , David T Rubin  3
Affiliations
Review

Evolving role of endoscopy in inflammatory bowel disease: Going beyond diagnosis

Paulina Núñez F et al. World J Gastroenterol. .

Abstract

Inflammatory bowel disease, encompassing Crohn's disease (CD) and ulcerative colitis, are chronic immune-mediated inflammatory bowel diseases (IBD) that primarily affect the gastrointestinal tract with periods of activity and remission. Large body of evidence exist to strengthen the prognostic role of endoscopic evaluation for both disease activity and severity and it remains the gold standard for the assessment of mucosal healing. Mucosal healing has been associated with improved clinical outcomes with prolonged remission, decreased hospitalization, IBD-related surgeries and colorectal cancer risk. Therefore, endoscopic objectives in IBD have been incorporated as part of standard care. With the known increased risk of colorectal cancer in IBD, although prevention strategies continue to develop, regular surveillance for early detection of neoplasia continue to be paramount in IBD patients' care. It is thanks to evolving technology and visualization techniques that surveillance strategies are continuously advancing. Therapeutic endoscopic options in IBD have also been expanding, from surgery sparing therapies such as balloon dilation of fibrostenotic strictures in CD to endoscopic mucosal resection of neoplastic lesions. In this review article, we discuss the current evidence on the use of endoscopy as part of standard of care of IBD, its role in surveillance of neoplasia, and the role of interventional endoscopic therapies.

Keywords: Crohn’s disease; Endoscopy; Inflammatory bowel disease; Surveillance; Therapeutic endoscopy; Ulcerative colitis.

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Conflict of interest statement

Conflict-of-interest statement: Rubin DT has received grant support from Takeda; and has served as a consultant for Abbvie, Altrubio, Allergan Inc., Arena Pharmaceuticals, Bellatrix Pharmaceuticals, Boehringer Ingelheim Ltd., Bristol-Myers Squibb, Celgene Corp/Syneos, Connect BioPharma, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, InDex Pharmaceuticals, Ironwood Pharmaceuticals, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Materia Prima, Pfizer, Prometheus Biosciences, Reistone, Takeda, and Techlab Inc. Quera R and Nuñez F Phave received support for attending meetings from Janssen.

Figures

Figure 1
Figure 1
Endoscopic index in inflammatory bowel diseases[13-22]. The Simple endoscopic score Crohn´s disease: Sum of values of the four variables for the five bowel segments (rectum, left colon, transverse colon, right colon and ileum). UCEIS: Ulcerative colitis endoscopic index of severity; SES CD: Simple endoscopic score Crohn´s disease; IBD: Inflammatory bowel diseases.
Figure 2
Figure 2
Endoscopic objectives in inflammatory bowel diseases treatment[8-22]. CCR: Colorectal cancer; UC: Ulcerative colitis; CD: Crohn’s disease; IPAA: Ileal-pouch-anal anastomoses; SES-CD: Simple endoscopic score Crohn´s disease; UCEIS: Ulcerative colitis endoscopic index of severity.
Figure 3
Figure 3
Inflammatory bowel diseases surveillance[3,24-28]. CCR: Colorectal cancer; IBD: Inflammatory bowel diseases; UC: Ulcerative colitis.
Figure 4
Figure 4
Algorithm for the management of dysplasia[3,37,42-46]. LGD: Low grade dysplasia; HGD: High grade dysplasia; CE: Chromoendoscopy.
See this image and copyright information in PMC

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