Abstract

The evaluation of small bowel in inflammatory bowel disease (IBD) is mainly performed in cases with newly diagnosed or suspected Crohn’s disease (CD). The available modalities for small bowel evaluation include radiological imaging (barium meal follow through, magnetic resonance enteroclysis, computed tomography enteroclysis) and small bowel endoscopy also known as enteroscopy. The main advantage of small bowel endoscopy over radiological imaging is that it allows for obtaining biopsy specimen required for histological confirmation of the diagnosis. Various endoscopic modalities for endoscopic evaluation of small bowel include push enteroscopy and device assisted enteroscopy (DAE). Push enteroscopy allows only limited evaluation of proximal small bowel. Therefore, DAE is generally preferred over push enteroscopy for small bowel evaluation. DAE includes single balloon enteroscopy, double balloon enteroscopy, and spiral enteroscopy. The available literature suggests that there is no significant difference in the diagnostic yield among the available DAE devices. Therefore, the choice of DAE is largely dependent on the availability as well as local expertise. More recently, motorised spiral enteroscopy has been introduced. The main advantage of this novel DAE is ease of use with the possibility of evaluating the entire small bowel via per-oral route. However, the data regarding the use of motorised spiral enteroscopy is limited and comparative trials are required in future.

Highlights

  • Evaluation of the small bowel in inflammatory bowel disease (IBD) is indicated primarily in patients with newly diagnosed or suspected Crohn’s disease (CD) [1]

  • Small bowel evaluation can be helpful in IBD- unclassified (IBD-U) who can be re-classified as CD in a significant number of cases

  • Endoscopic evaluation of small bowel can be done by small bowel video capsule endoscopy (VCE) (Figure 1A), push enteroscopy, Endoscopy in Small Bowel Diseases device assisted enteroscopy (DAE) (Figure 1C) and intra-operative enteroscopy (IOE) (Figure 1D) [2]

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Summary

Introduction

Evaluation of the small bowel in inflammatory bowel disease (IBD) is indicated primarily in patients with newly diagnosed or suspected Crohn’s disease (CD) [1]. Small bowel evaluation is warranted in all newly diagnosed cases of CD as small bowel is involved in every 2 out of 3 CD patients and the involvement can be discontinuous. In this scenario, cross sectional imaging (CTE/MRE) is preferred over VCE due to its potential to assess transmural and extra-luminal disease. Patients with suspected small bowel involvement on cross sectional imaging or VCE, DAE with small bowel biopsy can provide definitive evidence of CD.

Indications of SB endoscopy in IBD
Role of small bowel endoscopy in suspected CD
VCE in CD
VCE in suspected small bowel CD
Role of VCE scores to evaluate CD
Role of patency capsule
Assessment of postoperative CD recurrence
Assessment of IBD-unclassified (IBD-U)
Enteroscopy in IBD
SBE/DBE
SE/NMSE
Indications of DAE in CD
Diagnostic DAE
Study design Retrospective
Therapeutic DAE
DAE in paediatric patients
Complications of DAE
Intra-operative enteroscopy in CD
Findings
Conclusion
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