ASGE Adult and Pediatric Gastroenterology and Endoscopy Board Preparatory and Review Course | 2022-Irani

Irani_ASGE Endosocpic Management of IBD

Pdf Summary

This document is a summary of a presentation on the endoscopic management of inflammatory bowel disease (IBD), specifically focusing on chromoendoscopy, stricture management, surveillance for colorectal cancer (CRC), capsule endoscopy, and CT/MR enterography. The presenter emphasizes the importance of repeat colonoscopy with chromoendoscopy in patients with IBD who have abnormal findings on initial colonoscopy, as visible lesions can be missed with high-definition white light endoscopy. The risk factors for CRC in patients with IBD are discussed, along with the recommended timing and frequency of colonoscopy surveillance for dysplasia. Chromoendoscopy is recommended for high-risk patients with IBD, and targeted biopsies are found to be more cost-effective for detecting dysplasia. The use of dye-spray chromoendoscopy or virtual chromoendoscopy is recommended for detecting dysplasia, but nontargeted biopsies are not routinely required. The document also discusses the management of strictures in IBD, highlighting the diagnostic modalities such as endoscopy, CT enterography, MR enterography, intestinal ultrasound, and small bowel capsule. The safety and predictors of successful dilation for stricture management are mentioned, along with the importance of obtaining tissue samples to rule out malignancy. The best management options for patients with symptomatic small bowel strictures are discussed, including surgical referral for small bowel resection or strictureplasty. The document concludes with some key take-home points and additional resources for further reading.

Keywords

endoscopic management

inflammatory bowel disease

chromoendoscopy

stricture management

surveillance

colorectal cancer

capsule endoscopy

CT enterography

MR enterography

dysplasia