ASGE Postgraduate Course at ACG: Innovative Practices for the Endoscopist of Today, Tomorrow and Beyond | October 2023-9_Christie_ASGE Presidential Lecture Endoscopy in Functional Bowel Disorders

9_Christie_ASGE Presidential Lecture Endoscopy in Functional Bowel Disorders

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Dr. Jennifer Christie’s presentation on endoscopy for functional colon and rectal disorders at the 2023 ACG conference outlines the current and future roles of endoscopic technologies in diagnosing and managing functional bowel disorders (FBDs). She addresses several key aspects:<br /><br />**Current Role of Endoscopy:**<br />1. **Assessment of Mucosa:** Endoscopy is vital in evaluating mucosal integrity and administering therapy, especially for fecal incontinence (FI), constipation, and irritable bowel syndrome (IBS). It is most beneficial in IBS patients with diarrhea (IBS-D).<br />2. **Fecal Incontinence (FI) Management:** Endoscopy assesses mucosal changes and guides therapy. Diagnostic tests like flexible sigmoidoscopy, colonoscopy, and high-resolution anorectal manometry help determine the underlying causes of FI, which range from sphincter defects to neurological conditions.<br />3. **Therapeutic Interventions:** Techniques such as endoscopic ultrasound (EUS) guide anal sphincter investigations and therapies. Treatments include NASHA DX injections for FI, which show long-term efficacy and moderate side effects.<br /><br />**Future Endoscopic Technologies:**<br />1. **Endoflip:** This technique assesses anal distensibility and has shown a 70% correlation with high-resolution anorectal manometry. It offers a less invasive option for diagnosing FI.<br />2. **EUS-guided Sphincteroplasty:** Preliminary studies demonstrate that EUS can help with sphincteroplasty, showing promising results for severe anal sphincter injuries.<br /><br />**Long-term Prospects:**<br />1. **Mucosal Biofilms:** Research indicates that mucosal biofilms might serve as endoscopic markers for IBS, allowing more targeted management.<br />2. **Artificial Intelligence (AI):** AI systems are being developed to assess sensation, motility, and mucosal microenvironments, enhancing diagnostic precision.<br /><br />**Key Takeaways:**<br />- Endoscopy plays a crucial role in assessing mucosal integrity and guiding biopsies for FBDs.<br />- EUS significantly aids in evaluating and treating FI.<br />- Emerging technologies like Endoflip, mucosal biofilms, and AI hold potential for advancing the diagnosis and management of FBDs beyond current practices.<br /><br />Understanding these advancements can help gastroenterologists provide better patient outcomes through more precise and targeted therapies.

Keywords

endoscopy

functional bowel disorders

fecal incontinence

irritable bowel syndrome

EUS

Endoflip

mucosal biofilms

artificial intelligence

sphincteroplasty

gastroenterology