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

11_Dhere_Updates in IBD

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The document provides a comprehensive overview of the latest developments in the endoscopic management of Inflammatory Bowel Disease (IBD), as presented by Dr. Tanvi Dhere from Emory Division of Digestive Diseases. It underlines the importance of advanced endoscopic techniques in treating IBD-related complications, such as strictures, fistulas, abscesses, colitis-associated neoplasia (CAN), and adverse events following IBD surgery.<br /><br />Key points include:<br /><br />1. **Strictures**:<br />   - 20-40% of Crohn's disease patients develop strictures within 10 years. <br />   - Endoscopic balloon dilation (EBD), stricturotomy, and stent placement are highlighted strategies.<br />   - EBD can delay surgery by up to 6.5 years but may require multiple sessions. The recurrence rate at five years is up to 60%.<br /><br />2. **Endoscopic Management Techniques**:<br />   - Both EBD and electroincision techniques are essential tools.<br />   - The report covers success rates, technical procedures, and the effectiveness of these methods. For example, EBD shows major adverse events in about 4% of cases.<br /><br />3. **Fistulas/Abscesses**:<br />   - Endoscopic fistulotomy and drainage using stents are highlighted.<br />   - The paper suggests endoscopy, particularly for smaller, less complex fistulas, and abscess drainage where percutaneous techniques are challenging.<br /><br />4. **Colitis-associated Neoplasia**:<br />   - Surveillance methods like white light endoscopy and chromoendoscopy are crucial for early detection.<br />   - Endoscopic resection is proposed for polypoid lesions with clear margins but not recommended for multifocal or cancerous lesions. Studies show high success and manageable adverse event rates.<br /><br />5. **Post-surgical Complications**:<br />   - Endoscopy can manage complications like leaks or sinuses post-IBD surgery. Techniques such as endoscopic sinusotomy or application of tissue sealants are beneficial.<br /><br />The conclusion emphasizes the role of endoscopic interventions in delaying or preventing surgery. It calls for more specialized interventionists to address the needs of complex IBD cases, making these procedures integral parts of a multidisciplinary approach.

Keywords

Inflammatory Bowel Disease

endoscopic management

strictures

fistulas

abscesses

colitis-associated neoplasia

endoscopic balloon dilation

endoscopic fistulotomy

post-surgical complications

advanced endoscopic techniques