ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond

11_Dhere_Updates in IBD

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In her presentation on the "Updates in the Endoscopic Management of IBD," Dr. Tanvi Dhere, an Associate Professor at Emory University, outlines the advantages of advanced endoscopic techniques in treating Inflammatory Bowel Disease (IBD). The session addresses the endoscopic management of strictures, fistulas, abscesses, colitis-associated neoplasia (CAN), and complications following IBD surgery. <br /><br />**Key Techniques and Benefits:**<br />1. **Stricture Management:**<br />   - Strictures are common in Crohn's disease, with 20-40% of patients developing them within ten years of diagnosis. Techniques like endoscopic balloon dilation (EBD), stricturotomy, and stent placements are highlighted for their efficacy in prolonging the need for surgical intervention, preserving bowel length, and managing anastomotic strictures effectively.<br />   - EBD's success is noted, with a technical success rate approaching 89%. However, recurrence is high (up to 60% at 5 years), and around one-third may eventually need surgery.<br /><br />2. **Fistula and Abscess Management:**<br />   - Endoscopic fistulotomy is recommended for short, superficial fistulas, while endoscopic drainage using stents can manage abscesses effectively, particularly when interventional radiology poses challenges.<br />   <br />3. **Colitis-associated Neoplasia (CAN):**<br />   - Surveillance and early detection methods through high-definition white light endoscopy and chromoendoscopy have reduced the incidence of cancer in IBD patients. Endoscopic resection is recommended for single, well-defined lesions but not for multifocal or cancerous ones.<br />   - Techniques like Endoscopic Submucosal Dissection (ESD) and Endoscopic Mucosal Resection (EMR) are crucial for regions with submucosal fibrosis due to IBD.<br /><br />**Summary:**<br />Interventional endoscopic procedures are integral to managing IBD, enabling delayed or avoided surgeries, effectively treating complications, and preserving bowel integrity. Candidacy for these advanced techniques should be evaluated by a multidisciplinary team, emphasizing the need for specialized IBD interventionists to cater to complex cases. This integrated approach can significantly improve outcomes for IBD patients, offering safe, efficacious, and less invasive alternatives to traditional surgical methods.

Keywords

Endoscopic Management

IBD

Stricture Management

Fistula Management

Abscess Management

Colitis-associated Neoplasia

Endoscopic Balloon Dilation

Endoscopic Submucosal Dissection

Endoscopic Mucosal Resection

Advanced Techniques