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 presented on the role of endoscopy in managing functional colon and rectal disorders during the ASGE PG course at ACG 2023. Disclosures reveal her consulted for companies including Olympus and Takeda Pharmaceuticals. The session aimed to elucidate: the current utility of endoscopy in functional bowel disorders (FBDs), future endoscopic technologies, and potential roles beyond current practices.<br /><br />Functional bowel disorders, affecting over a quarter of adults, necessitate gastrointestinal (GI) consults frequently. Endoscopy today assesses mucosal integrity and aids in therapy for fecal incontinence (FI) and irritable bowel syndrome, particularly IBS-D. FI is a distressing condition impacting 2%-17% of individuals, predominantly women, and is linked to issues like anxiety, depression, and social isolation.<br /><br />Suggested evaluations for FI include flexible sigmoidoscopy, anal manometry, and anal ultrasonography. Colonoscopy is recommended for age-appropriate FI cases, random biopsies, and assessing mucosal conditions like proctitis. High-resolution anorectal manometry offers detailed analyses of sphincter pressures and reflexes. Endoscopic ultrasound (EUS) aids in visualizing anal sphincter structure, guiding therapy.<br /><br />Management strategies for FI cover general care, medication for incontinence and diarrheal urgency, and procedures like NASHA DX injection, which while effective, may cause adverse reactions like anorectal discomfort or hemorrhage. Studies hint toward the utility of endoscopic advancements for future management, including Endoflip for assessing FI and EUS-guided sphincteroplasty.<br /><br />Research underscores that without alarming features, there's minimal diagnostic yield for endoscopies in IBS patients. However, endoscopic features like mucosal biofilms might enhance understanding and future diagnosis of IBS. Artificial intelligence (AI) emerges as critical in analyzing endoscopic images and exploring 3D functional luminal imaging.<br /><br />In conclusion, Dr. Christie emphasized endoscopy's current role in mucosal examination and FI therapy guidance. Future scopes include innovative technologies like AI, biofilms, and advanced imaging techniques poised to transform FBDs assessment and treatment.

Keywords

endoscopy

functional bowel disorders

fecal incontinence

irritable bowel syndrome

artificial intelligence

mucosal integrity

anorectal manometry

endoscopic ultrasound

future technologies

AI in endoscopy