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World J Gastroenterol. Oct 21, 2020; 26(39): 5944-5958
Published online Oct 21, 2020. doi: 10.3748/wjg.v26.i39.5944
Enteroscopy in children and adults with inflammatory bowel disease
Giovanni Di Nardo, Gianluca Esposito, Chiara Ziparo, Federica Micheli, Luigi Masoni, Maria Pia Villa, Pasquale Parisi, Maria Beatrice Manca, Flavia Baccini, Vito Domenico Corleto
Giovanni Di Nardo, Chiara Ziparo, Maria Pia Villa, Pasquale Parisi, Chair of Pediatrics, Pediatric Gastroenterology and Endoscopy Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’ Andrea University Hospital, Rome 00189, Lazio, Italy
Gianluca Esposito, Department of Medical-Surgical Sciences and Translational Medicine, Sant’ Andrea Hospital, Sapienza University of Rome, Rome 00189, Lazio, Italy
Federica Micheli, Flavia Baccini, Vito Domenico Corleto, Department of Medical-Surgical Sciences and Translational Medicine, Sant’ Andrea University Hospital, Sapienza University of Rome, Rome 00189, Lazio, Italy
Luigi Masoni, Department of Surgery, Sapienza University of Rome, Sant’ Andrea University Hospital, Rome 00189, Lazio, Italy
Maria Beatrice Manca, Department of Clinical and Surgical Translational Medicine, Anesthesia and Intensive Care Medicine, Sant'Andrea University Hospital, Sapienza University of Rome 00189, Lazio, Italy
Author contributions: Di Nardo G, Villa MP and Parisi P wrote the pediatric section of the paper; Ziparo C and Manca MB collected and analyzed pediatric literature; Esposito G, Masoni L and Corleto VD wrote the adult section of the paper; Micheli F and Baccini F collected and analyzed adult literature.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Giovanni Di Nardo, MD, PhD, Assistant Professor, Chair of Pediatrics, Pediatric Gastroenterology and Endoscopy Unit, NESMOS Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Sant’ Andrea University Hospital, Via di Grottarossa 1035-1039, Rome 00189, Lazio, Italy. giovanni.dinardo@uniroma1.it
Received: June 28, 2020
Peer-review started: June 28, 2020
First decision: July 28, 2020
Revised: August 8, 2020
Accepted: September 25, 2020
Article in press: September 25, 2020
Published online: October 21, 2020
Processing time: 114 Days and 22.8 Hours
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: Enteroscopy; Device assisted enteroscopy; Inflammatory bowel disease; Crohn’s disease; Small bowel disease; Endoscopic balloon dilation

Core Tip: Evaluation of the small bowel (SB) mucosa is essential in differentiating Crohn’s disease (CD) from other enteropathies to achieve therapeutic decisions and to plan follow-up. The introduction of cross-sectional imaging techniques and capsule endoscopy have significantly improved the diagnostic approach to SB disease providing a non-invasive diagnostic method for the visualization of the entire SB mucosa. However, Device assisted enteroscopy (DAE) has further revolutionized management of SB-CD enabling histological confirmation and allowing therapeutic interventions. In the current review we will discuss technical aspect, indications and safety profile of DAE in children and adults with inflammatory bowel disease.