Recent Advances of Endoscopy in Inflammatory Bowel Diseases

Endoscopy plays a key role in the diagnosis and treatment in inflammatory bowel disease (IBD). The most valuable tool for distinguishing different types of IBD is a complete ileocolonoscopy with mucosal biopsy. Endoscopic localization of the disease not only aids in determining prognosis and appropriateness of medical therapies but also aids decision-making in those undergoing surgical therapy. With regard to therapeutic applications, obstructive symptoms caused by benign fibrotic strictures can be treated adequately by endoscopic balloon dilation. Epidemiological studies have demonstrated an increased risk of colorectal cancer in patients with both ulcerative colitis and colonic Crohn's disease (CD). Colonoscopy is currently considered to be the gold standard for cancer surveillance. Published guidelines recommend that two to four biopsy samples should be obtained every 10 cm in the colorectum, necessitating 20-50 samplings per examination. This may result in standard colonoscopy - which is also very time-consuming and laborious - missing significant numbers of small lesions. Various novel techniques have been applied to reduce the required number of biopsy samples and the duration of examinations, including chromoendoscopy with or without magnification, fluorescence endoscopy, narrow-band imaging, optical coherence tomography, and confocal laser endomicroscopy. Until recently the only way to evaluate the small-bowel mucosa in a patient with CD was by barium small-bowel radiographs and intubation of the distal terminal ileum. Both wireless-capsule endoscopy (WCE) and double-balloon enteroscopy (DBE) allow light to be used in the inspection of the small bowel and may replace radiological methods. WCE is more convenient than DBE for probing small-bowel mucosal changes, but only DBE allows a biopsy sample to be obtained from the deep small bowel, and these two examinations can be considered complementary. The wider application of new techniques in the near future might increase the role played by endoscopy in the management of IBD. (Gut and Liver 2007;1:118-125)