Endoscopy In Inflammatory Bowel Disease Research Articles

Role of capsule endoscopy in inflammatory bowel disease

Capsule endoscopy (CE) is an innovative technological breakthrough that for the first time provides a noninvasive method to obtain high-resolution imaging of the entire small bowel. Since its recent inception, the diagnostic utility of CE has become well established for the evaluation of diverse ulcerative and inflammatory disorders of the jejunum and ileum. The incredible resolution of its lens (0.1 mm) detects focal villous edema or atrophy, denuded, as well as ulcerated mucosal lesions missed by other imaging techniques. CE has been shown by meta-analysis to be a more sensitive method to investigate patients for small bowel Crohn's disease, with an incremental yield above 30% versus other imaging modalities. In patients with indeterminate colitis, CE is useful in distinguishing between ulcerative and Crohn's colitis. Among patients with established Crohn's disease, CE may be employed to determine: (1) the extent and severity of small bowel involvement, (2) postoperative recurrence, (3) post-therapy mucosal healing, and (4) whether active small bowel inflammatory lesions exist in the clinical setting of functional bowel disorder. Complications are rare and include capsule retention at stricture sites. The new patency capsule can diminish the risk of the latter problem in at-risk patients. CE can also serve as a guide to sites that require biopsies or dilatation by push or double-balloon enteroscopy. However, other causes of small bowel lesions may mimic Crohn's disease. A standard terminology system has thus been developed, and a CE Crohn's disease severity scoring index is currently undergoing validation studies.

Wireless Capsule Endoscopy in Inflammatory Bowel Disease: State of the Art and Image of the Future

Wireless Capsule Endoscopy in Inflammatory Bowel Disease: State of the Art and Image of the Future

Endoscopy in inflammatory bowel diseases

A correct diagnosis, adequate assessment of disease activity, avoidance of surgery by endoscopic interventions, and effective cancer surveillance make endoscopy crucial in the management of inflammatory bowel diseases (IBDs). Impressive technical developments of several endoscopic techniques over the past few decades have allowed a detailed visual impression of the affected gut and enable tissue sampling and various therapeutic interventions. Here we propose guidelines for endoscopy in inflammatory bowel disease, and review all currently available endoscopic techniques relevant to the proper treatment of IBD patients.

Can Capsule Endoscopy Help Differentiate the Aetiology of Indeterminate Colitis?

BACKGROUND: The role of capsule endoscopy in inflammatory bowel disease is evolving and its role in patients with indeterminate colitis is unknown.

Upper gastrointestinal tract endoscopy in inflammatory bowel disease.

Upper gastrointestinal endoscopy is used to evaluate upper gastrointestinal symptoms in patients with inflammatory bowel disease. This article discusses the procedure, which may allow for the diagnosis of Crohn's disease of the esophagus, stomach, and/or duodenum. Biopsies of normal gastric mucosa in patients with indeterminate colitis may be helpful in making a diagnosis of Crohn's colitis. Upper gastrointestinal endoscopy may allow for therapeutic intervention in terms of bleeding and stricturing disease.

Enhanced endoscopy in inflammatory bowel disease.

Spectroscopy and OCT are two new methods for imaging the gastrointestinal mucosa. They both rely on the interaction of light within a tissue and have been adapted for use with endoscopes. It is unlikely that any one type of imaging modality will be able to reliably diagnose the presence of microscopic dysplasia. However, combining different methods may prove to be extremely accurate for detecting dysplasia and may therefore obviate a need for taking tissue biopsies. For instance, LSS may be most helpful in detecting early dysplasia because it is sensitive to changes in nuclear size and crowding. As more cells become dysplastic, fluorescence may play a role in defining changes in content of collagen or markers of metabolism (i.e. NADH). Finally, reflectance spectroscopy becomes useful in detecting characteristic changes in the tissue architecture as dysplasia progresses to invasive cancer. Using all three types of spectroscopy at once ("tri-modal spectroscopy") has proven to be extremely accurate for classifying Barrett's mucosa as either dysplastic or nondysplastic [9]. Our current method for detecting microscopic dysplasia relies upon random biopsies and interpretation of histology by pathologists. Interobserver agreement among even experienced pathologists regarding the presence or absence and degree of dysplasia in histologic specimens is not consistent [50]. Spectroscopy and OCT may ultimately provide new methods for accurately diagnosing dysplasia in real-time, without the need for tissue processing, and without the interobserver variations of histologic interpretation.

Endoscopy in inflammatory bowel disease

With the heterogeneous clinical presentation of IBD, endoscopy plays an integral role in the initial diagnosis of ulcerative colitis and Crohn's disease. Although radiographic tests often are supplemental in the work-up of IBD, colonoscopy with biopsy is the test of choice if IBD is suspected and is more sensitive than radiographic tests. Endoscopic features can be helpful in differentiating ulcerative colitis and Crohn's disease. Currently the only mode for detecting dysplasia and stratifying the risk of developing colorectal cancer is through complete colonoscopy with multiple biopsy specimens. Complications of IBD can be managed effectively with endoscopic therapy. The role of endoscopic ultrasound and future developments in endoscopic therapy need to be defined by future studies.

Role of Endoscopy in Inflammatory Bowel Disease

Since its introduction into clinical use, flexible fiberoptic endoscopy progressively has become an indispensable tool to diagnose and treat gastrointestinal disorders. Few innovations have had a greater impact on the clinical practice of gastroenterology. In effect, diagnostic endoscopy has become an extension of physical diagnosis. This article reviews the expanding use of endoscopy in inflammatory bowel disease in the pediatric age group.

The role of endoscopy in inflammatory bowel disease

Endoscopy has assumed a preeminent role in the diagnostic approach to IBD. It is more sensitive than radiography in detecting early, subtle changes of IBD, both through endoscopic appearance and histologic sampling of mucosa. Endoscopy also appears to be a safe technique in patients presenting with severe forms of colitis and can play an important role in defining the etiologic basis of disease in this subgroup of patients. In addition to its diagnostic role, endoscopy has proven useful in surveying disease activity, through the development of endoscopic disease activity indices. Endoscopy has also found a prominent role in the diagnostic and therapeutic approach to IBD complications. Endoscopic surveillance of chronic UC patients at risk for colon carcinoma has helped to define a therapeutic approach to this serious complication of UC. Endoscopic therapy has been applied to treat stricture formation associated with long-standing CD. Biliary endoscopy also represents the strategy of choice for diagnosing primary sclerosing cholangitis, an extraintestinal complication occurring in 5% of UC patients. Finally, endoscopy may help facilitate the discovery of disease pathogenesis in IBD, through the use of endoscopically recovered biopsy specimens in the research laboratory. Endoscopy allows for ready access to human tissue that has been the cornerstone of disease-related research over the past two decades.

Applications and Pitfalls of Endoscopy in Inflammatory Bowel Disease

The role of upper gastrointestinal and hepatobiliary endoscopy and colonoscopy in the diagnosis and management of patients with inflammatory bowel disease (IBD) is reviewed. The differentiation of IBD from other forms of colitis, mass lesions in the colon, strictures and polyps, and the management of the patient with dysplasia including clinical strategies for early detection are discussed. The role and value of endoscopic surveillance programs have yet to be defined.

Endoscopy in Inflammatory Bowel Disease: Indications and Differential Diagnosis

Colonoscopy with multiple biopsies adds a considerable amount of information to the overall clinical approach to the patient with inflammatory bowel disease. Because colonoscopy is an invasive procedure requiring a vigorous bowel clean-out, it is not a first-line investigative procedure for patients with inflammatory bowel disease. However, in certain indicated circumstances, colonoscopy can assist greatly in the management and diagnosis of patients with inflammatory bowel disease.

Role of endoscopy in inflammatory bowel disease.

Over the past two decades, endoscopy has emerged as the single most important tool in the initial diagnosis and subsequent follow-up of inflammatory bowel disease. This article is an overview of the applicability of the various endoscopic procedures in the management of inflammatory bowel disease and its complications.