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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Dec 16, 2016; 8(20): 723-732
Published online Dec 16, 2016. doi: 10.4253/wjge.v8.i20.723
Endoscopic evaluation in diagnosis and management of inflammatory bowel disease
Carthage P Moran, Barra Neary, Glen A Doherty
Carthage P Moran, Barra Neary, Glen A Doherty, Centre for Colorectal Disease, St. Vincent’s University Hospital and School of Medicine, University College Dublin, D04 T6F4 Dublin, Ireland
Author contributions: Moran CP and Neary B performed literature review and wrote the paper; Doherty GA contributed critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: No conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Carthage P Moran, MB, Centre for Colorectal Disease, St. Vincent’s University Hospital and School of Medicine, University College Dublin, Elm Park, Dublin 4, D04 T6F4 Dublin, Ireland. cmoran@ucc.ie
Telephone: +353-1-2214134
Received: March 30, 2016
Peer-review started: April 5, 2016
First decision: June 12, 2016
Revised: August 16, 2016
Accepted: September 21, 2016
Article in press: September 22, 2016
Published online: December 16, 2016
Processing time: 259 Days and 2.4 Hours
Abstract

Endoscopy is a keystone in the management of patients with inflammatory bowel disease (IBD). It is the fundamental diagnostic tool for IBD, and can help discern between ulcerative colitis and Crohn’s disease. Endoscopic assessment provides an objective end point in clinical trials, and identifies patients in clinical practice who may benefit from treatment escalation and may assist risk stratification in patients seeking to discontinue therapy. Recent advances in endoscopic assessment of patients with IBD include video capsule endoscopy, and chromoendoscopy. Technological advances enable improved visualization and focused biopsy sampling. Endoscopic resection and close surveillance of dysplastic lesions where feasible is recommended instead of prophylactic colectomy.

Keywords: Inflammatory bowel disease; Ulcerative colitis; Crohn’s disease; Endoscopy; Capsule endoscopy; Cancer surveillance; Colonoscopy

Core tip: Ileo-colonoscopy remains the most important test in the diagnosis and monitoring of inflammatory bowel disease (IBD). Video capsule endoscopy shows very high sensitivity for small bowel mucosal lesions not accessible to conventional flexible endoscopes. Both techniques facilitate monitoring of response to treatment. Endoscopic activity indices are important for monitoring treatment response and can help identify patients who may benefit from treatment escalation. Colorectal cancer surveillance in patients with IBD is shifting from high frequency random biopsies, to that of high quality visual inspection and targeted biopsies of suspected dysplasia, enabled by technological advances including chromoendoscopy and high-definition endoscopes.