Clinical Endoscopy

Systematic Review and Meta-analysises

Efficacy and safety of endoscopic submucosal dissection for colorectal dysplasia in patients with inflammatory bowel disease: a systematic review and meta-analysis: Talia F. Malik, Vaishnavi Sabesan, Babu P. Mohan, Asad Ur Rahman, Mohamed O. Othman, Peter V. Draganov, Gursimran S. Kochhar; Clin Endosc 2024;57(3):317-328. Published online February 29, 2024; DOI: https://doi.org/10.5946/ce.2023.205

Graphical Abstract Abstract PDF Supplementary Material PubReader ePub: Background
/Aims: In this meta-analysis, we studied the safety and efficacy of endoscopic submucosal dissection (ESD) for colorectal dysplasia in patients with inflammatory bowel disease (IBD).
Methods
Multiple databases were searched, and studies were retrieved based on pre-specified criteria until October 2022. The outcomes assessed were resection rates, procedural complications, local recurrence, metachronous tumors, and the need for surgery after ESD in IBD. Standard meta-analysis methods were followed using the random-effects model, and I2% was used to assess heterogeneity.
Results
Twelve studies comprising 291 dysplastic lesions in 274 patients were included with a median follow-up of 25 months. The pooled en-bloc resection, R0 resection, and curative resection rates were 92.5% (95% confidence interval [CI], 87.9%–95.4%; I2=0%), 81.5% (95% CI, 72.5%–88%; I2=43%), and 48.9% (95% CI, 32.1%–65.9%; I2=87%), respectively. The local recurrence rate was 3.9% (95% CI, 2%–7.5%; I2=0%). The pooled rates of bleeding and perforation were 7.7% (95% CI, 4.5%–13%; I2=10%) and 5.3% (95% CI, 3.1%–8.9%; I2=0%), respectively. The rates of metachronous recurrence and additional surgery following ESD were 10% (95% CI, 5.2%–18.2%; I2=55%) and 13% (95% CI, 8.5%–19.3%; I2=54%), respectively.
Conclusions
ESD is safe and effective for the resection of dysplastic lesions in IBD with an excellent pooled rate of en-bloc and R0 resection.

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Stricturing Crohn's disease: what is the role of endoscopic stenting? A systematic review: Giorgia Burrelli Scotti, Roberto Lorenzetti, Annalisa Aratari, Antonietta Lamazza, Enrico Fiori, Claudio Papi, Stefano Festa; Clin Endosc 2023;56(6):726-734. Published online October 24, 2023; DOI: https://doi.org/10.5946/ce.2023.059

Graphical Abstract Abstract PDF PubReader ePub

Background
/Aims: Endoscopic stenting for stricturing Crohn's disease (CD) is an emerging treatment that achieves more persistent dilatation of the stricture over time than endoscopic balloon dilatation (EBD). We aimed to explore the efficacy and safety of stenting for the treatment of CD strictures.
Methods
A systematic electronic literature search was performed (PROSPERO; no. CRD42022308033). The primary outcomes were technical success, efficacy, complication rate, and the need for further interventions due to reobstruction. The outcomes of partially covered self-expanding metal stents (PCSEMS) with scheduled retrieval after seven days were also analyzed.
Results
Eleven eligible studies were included in the review. Overall, 173 patients with CD were included in this study. Mean percentage of technical success was 95% (range, 80%–100%), short-term efficacy was 100% in all studies, and long-term efficacy was 56% (range, 25%–90%). In patients with a scheduled PCSEMS retrieval, the long-term efficacy was 76% (range, 59%–90%), the mean complication rate was 35% (range, 15%–57%), and the major complication rate was 11% (range, 0%–29%).
Conclusions
Endoscopic stenting with scheduled PCSEMS retrieval may be considered a feasible second-line treatment for short CD strictures to postpone surgery. However, larger head-to-head prospective studies are needed to understand the role of stenting as an alternative or additional treatment to EBD in CD.

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Perioperative Considerations for the Surgical Treatment of Crohn’s Disease with Discussion on Surgical Antibiotics Practices and Impact on the Gut Microbiome
Shelbi Olson, Lindsay Welton, Cyrus Jahansouz
Antibiotics.2024; 13(4): 317. CrossRef

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Reviews

Current status of image-enhanced endoscopy in inflammatory bowel disease: Young Joo Yang; Clin Endosc 2023;56(5):563-577. Published online September 26, 2023; DOI: https://doi.org/10.5946/ce.2023.070

Abstract PDF PubReader ePub: In inflammatory bowel disease (IBD), chronic inflammation leads to unfavorable clinical outcomes and increases the risk of developing colorectal neoplasm (CRN); thereby highlighting the importance of endoscopically evaluating disease activity as well as detecting and characterizing CRN in patients with IBD. With recent advances in image-enhanced endoscopic (IEE) technologies, especially virtual chromoendoscopy (VCE) platforms, this review discusses state-of-the-art IEE techniques and their applicability in assessing disease activity and surveillance colonoscopy in patients with IBD. Among various IEE, VCE demonstrated the capacity to identify quiescent disease activity. And endoscopic remission defined by the new scoring system using VCE platform better predicted clinical outcomes, which may benefit the tailoring of therapeutic strategies in patients with IBD. High-definition dye-chromoendoscopy (HD-DCE) is numerically superior to high-definition white light endoscopy (HD-WLE) in detecting CRN in IBD; however, discrepancy is observed in the statistical significance. VCE showed comparable performance in detecting dysplasia to HD-WLE or DCE and potential for optical diagnosis to differentiate neoplastic from nonneoplastic lesions during surveillance colonoscopy. Applying these novel advanced IEE technologies would provide opportunities for personalized medicine in IBD and optimal treatment of CRN in patients with IBD.

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Recent advances in surveillance colonoscopy for dysplasia in inflammatory bowel disease: Soo-Young Na, Won Moon; Clin Endosc 2022;55(6):726-735. Published online November 18, 2022; DOI: https://doi.org/10.5946/ce.2022.132

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Inflammatory bowel disease (IBD) has a global presence with rapidly increasing incidence and prevalence. Patients with IBD including those with ulcerative colitis and Crohn’s disease have a higher risk of developing colorectal cancer (CRC) compared to the general population. Risk factors for CRC in patients with IBD include long disease duration, extensive colitis, primary sclerosing cholangitis, family history of CRC, stricture, and prior dysplasia. Surveillance colonoscopy for CRC in patients with IBD should be tailored to individualized risk factors and requires careful monitoring every year to every five years. The current surveillance techniques are based on several guidelines. Chromoendoscopy with targeted biopsy is being recommended increasingly, and high-definition colonoscopy is gradually replacing standard-definition colonoscopy. However, it remains unclear whether chromoendoscopy, virtual chromoendoscopy, or white-light endoscopy has better efficiency when a high-definition scope is used. With the development of new endoscopic instruments and techniques, the paradigm of surveillance strategy has gradually changed. In this review, we discuss cutting-edge surveillance colonoscopy in patients with IBD including a review of literature.

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Inflammatory bowel disease and primary sclerosing cholangitis: One disease or two?
Kim N. van Munster, Annika Bergquist, Cyriel Y. Ponsioen
Journal of Hepatology.2024; 80(1): 155. CrossRef
Extrachromosomal Circular DNA: An Emerging Potential Biomarker for Inflammatory Bowel Diseases?
Valentina Petito, Federica Di Vincenzo, Lorenza Putignani, Maria T. Abreu, Birgitte Regenberg, Antonio Gasbarrini, Franco Scaldaferri
Genes.2024; 15(4): 414. CrossRef
A Review of Colonoscopy in Intestinal Diseases
Seung Hong, Dong Baek
Diagnostics.2023; 13(7): 1262. CrossRef
Potential Oral Microbial Markers for Differential Diagnosis of Crohn’s Disease and Ulcerative Colitis Using Machine Learning Models
Sang-Bum Kang, Hyeonwoo Kim, Sangsoo Kim, Jiwon Kim, Soo-Kyung Park, Chil-Woo Lee, Kyeong Ok Kim, Geom-Seog Seo, Min Suk Kim, Jae Myung Cha, Ja Seol Koo, Dong-Il Park
Microorganisms.2023; 11(7): 1665. CrossRef
Update on Endoscopic Dysplasia Surveillance in Inflammatory Bowel Disease
Nayantara Coelho-Prabhu, James D. Lewis
American Journal of Gastroenterology.2023; 118(10): 1748. CrossRef

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Endoscopic activity in inflammatory bowel disease: clinical significance and application in practice: Kyeong Ok Kim; Clin Endosc 2022;55(4):480-488. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2022.108

Abstract PDF PubReader ePub

Endoscopy is vital for diagnosing, assessing treatment response, and monitoring surveillance in patients with inflammatory bowel disease (IBD). With the growing importance of mucosal healing as a treatment target, the assessment of disease activity by endoscopy has been accepted as the standard of care for IBD. There are many endoscopic activity indices for facilitating standardized reporting of the gastrointestinal mucosal appearance in IBD, and each index has its strengths and weaknesses. Although most endoscopic indices do not have a clear-cut validated definition, endoscopic remission or mucosal healing is associated with favorable outcomes, such as a decreased risk of relapse. Therefore, experts suggest utilizing endoscopic indices for monitoring disease activity and optimizing treatment to achieve remission. However, the regular monitoring of endoscopic activity is limited in practice owing to several factors, such as the complexity of the procedure, time consumption, inter-observer variability, and lack of a clear-cut, validated definition of endoscopic response or remission. Although experts have recently suggested consensus-based definitions, further studies are needed to define the values that can predict long-term outcomes.

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Plasminogen Activator Inhibitor 1 Is a Novel Faecal Biomarker for Monitoring Disease Activity and Therapeutic Response in Inflammatory Bowel Diseases
Boldizsár Jójárt, Tamás Resál, Diána Kata, Tünde Molnár, Péter Bacsur, Viktória Szabó, Árpád Varga, Kata Judit Szántó, Petra Pallagi, Imre Földesi, Tamás Molnár, József Maléth, Klaudia Farkas
Journal of Crohn's and Colitis.2024; 18(3): 392. CrossRef
Ocular endothelial dysfunction in pediatric inflammatory bowel disease
Giovanni Di Nardo, Mariachiara Di Pippo, Letizia Zenzeri, Maurizio Mennini, Marisa Piccirillo, Silvia Furio, Giovanna Quatrale, Melania Evangelisti, Pasquale Parisi, Livia Lucchini, Alessandro Ferretti, Maria Pia Villa, Gianluca Scuderi, David Sarzi Amadè
Journal of Pediatric Gastroenterology and Nutrition.2024; 78(6): 1297. CrossRef
Different levels of healing in inflammatory bowel diseases: mucosal, histological, transmural, barrier and complete healing
Markus F Neurath, Michael Vieth
Gut.2023; 72(11): 2164. CrossRef
Use of Standardized Inflammatory Bowel Disease Endoscopy Scores in Clinical Practice
Jill K J Gaidos, Badr Al Bawardy, Francis A Farraye, Miguel Regueiro
Crohn's & Colitis 360.2023;[Epub] CrossRef
Evaluation of Disease Activity in Inflammatory Bowel Disease: Diagnostic Tools in the Assessment of Histological Healing
Alina Ecaterina Jucan, Otilia Gavrilescu, Mihaela Dranga, Iolanda Valentina Popa, Ioana-Ruxandra Mihai, Vasile-Claudiu Mihai, Gabriela Stefanescu, Vasile Liviu Drug, Cristina Cijevschi Prelipcean, Radu-Alexandru Vulpoi, Oana-Bogdana Barboi, Irina Ciortesc
Biomedicines.2023; 11(11): 3090. CrossRef
Active Assessment of Inflammatory Bowel Disease
金良肖
Advances in Clinical Medicine.2022; 12(12): 11023. CrossRef

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Original Article

Capsule enteroscopy versus small-bowel ultrasonography for the detection and differential diagnosis of intestinal diseases: Luca Elli, Erica Centorrino, Andrea Costantino, Maurizio Vecchi, Stefania Orlando, Mirella Fraquelli; Clin Endosc 2022;55(4):532-539. Published online July 28, 2022; DOI: https://doi.org/10.5946/ce.2021.224

Abstract PDF PubReader ePub

Background
/Aims: Capsule enteroscopy (CE) and intestinal ultrasonography (IUS) are techniques that are currently used for investigating small-bowel (SB) diseases. The aim of this study was to compare the main imaging findings and the lesion detection rate (LDR) of CE and IUS in different clinical scenarios involving the SB.
Methods
We retrospectively enrolled patients who underwent CE and IUS for obscure gastrointestinal bleeding (OGIB), complicated celiac disease (CeD), and suspected or known inflammatory bowel disease (IBD). We evaluated the LDR of both techniques. The accuracy of IUS was determined using CE as the reference standard.
Results
A total of 159 patients (113 female; mean age, 49±19 years) were enrolled. The LDR was 55% and 33% for CE and IUS (p<0.05), respectively. Subgroup analysis showed that the LDR of CE was significantly higher than that of IUS in patients with OGIB (62% vs. 14%, p<0.05) and CeD (55% vs. 35%, p<0.05). IUS showed a similar LDR to CE in patients with suspected or known IBD (51% vs. 46%, p=0.83).
Conclusions
CE should be preferred in cases of OGIB and CeD, whereas IUS should be considered an early step in the diagnosis and follow-up of IBD even in patients with a proximal SB localization of the disease.

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Past, Present, and Future of Noninvasive Tests to Assess Gluten Exposure, Celiac Disease Activity, and End-Organ Damage
Jocelyn A. Silvester, Luca Elli, Chaitan Khosla, Jason A. Tye-Din
Gastroenterology.2024; 167(1): 159. CrossRef
A practical approach for small bowel bleeding
Sung Eun Kim, Hyun Jin Kim, Myeongseok Koh, Min Cheol Kim, Joon Sung Kim, Ji Hyung Nam, Young Kwan Cho, A Reum Choe
Clinical Endoscopy.2023; 56(3): 283. CrossRef
Small Bowel Imaging in Celiac Disease: Is there a role for Small Bowel Ultrasound?
Roberta Elisa Rossi, Anita Busacca, Luca Brandaleone, Benedetta Masoni, Sara Massironi, Mirella Fraquelli, Alessandro Repici
Current Gastroenterology Reports.2023; 25(12): 430. CrossRef

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Review

Endoscopic Diagnosis and Differentiation of Inflammatory Bowel Disease: Ji Min Lee, Kang-Moon Lee; Clin Endosc 2016;49(4):370-375. Published online July 29, 2016; DOI: https://doi.org/10.5946/ce.2016.090

Abstract PDF PubReader ePub

Patients with inflammatory bowel disease have significantly increased in recent decades in Korea. Intestinal tuberculosis (ITB) and intestinal Behcet’s disease (BD), which should be differentiated from Crohn’s disease (CD), are more frequent in Korea than in the West. Thus, the accurate diagnosis of these inflammatory diseases is problematic in Korea and clinicians should fully understand their clinical and endoscopic characteristics. Ulcerative colitis mostly presents with rectal inflammation and continuous lesions, while CD presents with discontinuous inflammatory lesions and frequently involves the ileocecal area. Involvement of fewer than four segments, a patulous ileocecal valve, transverse ulcers, and scars or pseudopolyps are more frequently seen in ITB than in CD. A few ulcers with discrete margins are a typical endoscopic finding of intestinal BD. However, the differential diagnosis is difficult in many clinical situations because typical endoscopic findings are not always observed. Therefore, clinicians should also consider symptoms and laboratory, pathological, and radiological findings, in addition to endoscopic findings.

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Recent Trends in Non-Invasive Methods of Diagnosis and Evaluation of Inflammatory Bowel Disease: A Short Review
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Case Report

Tracheal Involvement in Crohn Disease: the First Case in Korea: Seunghyun Park, Jongha Park, Hyun-Kuk Kim, Ji Yeon Kim, So Chong Hur, Ju Hyung Lee, Jae Won Jung, Juwon Lee; Clin Endosc 2016;49(2):202-206. Published online February 16, 2016; DOI: https://doi.org/10.5946/ce.2015.059; Correction in: Clin Endosc 2016;49(3):310

Abstract PDF PubReader ePub

Respiratory involvement in Crohn disease (CD) is rare condition with only about a dozen reported cases. We report the first case of CD with tracheal involvement in Korea. An 18-year-old woman with CD was hospitalized because of coughing, dyspnea, and fever sustained for 3 weeks. Because she had stridor in her neck, we performed computed tomography of the neck, which showed circumferential wall thickening of the larynx and hypopharynx. Bronchoscopy revealed mucosal irregularity, ulceration, and exudates debris in the proximal trachea, and bronchial biopsy revealed chronic inflammation with granulation tissue. Based on these findings, we suspected CD with tracheal involvement and began administering intravenous methylprednisolone at 1 mg/kg per day, after which her symptoms and bronchoscopic findings improved.

Citations

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Tracheobronchitis and laryngitis associated with Crohn's disease
Shogo Nakai, Moeko Morikawa, Toshiya Hiramatsu, Yurina Murakami, Koji Nishimoto, Sayomi Matsushima, Masanori Harada, Tomohiro Uto, Jun Sato, Shiro Imokawa, Takafumi Suda
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Managing Head and Neck Malignancy Arising in a Field of Crohn Disease Inflammation: Report of a Case
Christina Yver, Darshana Jhala, Amanda Muir, Devraj Basu
Ear, Nose & Throat Journal.2017; 96(10-11): E1. CrossRef

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Focused Review Series: Endoscopic Screening and Surveillance for Gastrointestinal Cancer

Colon Cancer Screening and Surveillance in Inflammatory Bowel Disease: Song I Bae, You Sun Kim; Clin Endosc 2014;47(6):509-515. Published online November 30, 2014; DOI: https://doi.org/10.5946/ce.2014.47.6.509

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Patients with inflammatory bowel disease (IBD) have an increased risk of developing colorectal cancer (CRC). Accordingly, the duration and anatomic extent of the disease have been known to affect the development of IBD-related CRC. When CRC occurs in patients with IBD, unlike in sporadic CRC, it is difficult to detect the lesions because of mucosal changes caused by inflammation. In addition, the tumor types vary with ill-circumscribed lesions, and the cancer is difficult to diagnose and remedy at an early stage. For the diagnosis of CRC in patients with IBD, screening endoscopy is recommended 8 to 10 years after the IBD diagnosis, and surveillance colonoscopy is recommended every 1 to 2 years thereafter. The recent development of targeted biopsies using chromoendoscopy and relatively newer endoscopic techniques helps in the early diagnosis of CRC in patients with IBD. A total proctocolectomy is advisable when high-grade dysplasia or multifocal low-grade dysplasia is confirmed by screening endoscopy or surveillance colonoscopy or if a nonadenoma-like dysplasia-associated lesion or mass is detected. Currently, pharmacotherapies are being extensively studied as a way to prevent IBD-related CRC.

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Focused Review Series: A Perspective: Endoscopy and Imagings in Inflammatory Bowel Disease

Computed Tomography Enterography for Evaluation of Inflammatory Bowel Disease: Min Jung Park, Joon Seok Lim; Clin Endosc 2013;46(4):327-366. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.327

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Computed tomography enterography (CTE) has become a main modality for the evaluation of inflammatory bowel disease (IBD). It simultaneously offers visualization of the small bowel and extraintestinal status, which is helpful for diagnosing IBD. Crohn disease has long segmental enhancing wall thickening related with the eccentric longitudinal distribution. In addition, mural stratification, fibrofatty proliferation, positive comb sign by increased mesenteric vascularity and internal/perianal fistula are characteristics of Crohn disease and can be identified on CTE. Short segmental inflammatory wall thickening and the central low attenuated lymph nodes are favorable CT finding of intestinal tuberculosis. A geographic, relatively large, and deep penetrating ulcer with bowel wall thickening and mural hyperenhancement in ileocecal area are characteristics of intestinal Behcet disease. Each of CTE findings for the IBDs is helpful for differential diagnosis. The main disadvantage of this technique is the requisite radiation exposure of patients, particularly in young patients. However, recent development of advanced CT techniques is promising for radiation dose reduction without compromising diagnostic image quality.

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The Role of Colonoscopy in Inflammatory Bowel Disease: Yong Gil Kim, Byung Ik Jang; Clin Endosc 2013;46(4):317-320. Published online July 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.4.317

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An endoscopic evaluation, particularly ileocolic mucosal and histological findings, is essential for the diagnosis of inflammatory bowel disease (IBD). The introduction of antitumor necrosis factor agents has changed the therapeutic paradigm of patients with IBD, but an endoscopic evaluation is more important to guide therapeutic decision-making. In the future, endoscopy with a histological evaluation will be increasingly used in patients with IBD. Both Crohn colitis and ulcerative colitis result in an increased incidence of colorectal carcinoma. Thus, surveillance colonoscopy is important to detect early neoplastic lesions. Surveillance ileocolonoscopy has also changed recently from multiple random biopsies to pancolonic dye spraying with targeted biopsies of abnormal areas.

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Original Article

The Early Onset of Disease May Be a Risk Factor for Decreased Bone Mineral Density in Patients with Inflammatory Bowel Disease: Hwa Jong Kim, Su Jin Hong, Young Woo Jeon, Jae Pil Han, Seung Hyo Han, Jee Heon Kang, Jae Woong Tae, Hee Sook Lim, Hee Kyung Kim, Bong Min Ko, Moon Sung Lee; Clin Endosc 2013;46(1):71-76. Published online January 31, 2013; DOI: https://doi.org/10.5946/ce.2013.46.1.71

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Background/Aims

The pathogenesis of bone loss in patients with inflammatory bowel disease (IBD) is complex, multifactorial, and only partly understood. We aimed to examine the extent and risk factors of bone mass reduction and to analyze the impact of early onset of a disease before attaining peak bone mass in IBD patients.

Methods

We compared the risk factors for osteoporosis and BMD at the lumbar spine and the hip bone in IBD patients.

Results

A total of 44 patients with IBD were enrolled. Twenty-one and 23 patients were diagnosed as IBD before and after the age of 30 and designated as group A and group B, respectively. Group A had significant bone mass reduction at the lumbar spine than group B (BMD, 1.01±0.10 vs. 1.14±0.17, p<0.01; T-score, -1.22±0.84 vs. -0.08±1.39, p<0.01; Z-score, -1.11±0.81 vs. -0.03±1.32, p<0.01, respectively). Multivariate analysis showed that patients diagnosed as IBD before the age of 30 had possible risk factor of bone mass reduction (hazard ratio, 3.96; p=0.06).

Conclusions

Bone mass reduction was more severe in patients who were diagnosed with IBD before the age of 30 than in those diagnosed after the age of 30.

Citations

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Special Issue Articles of IDEN 2012

Role of Computed Tomography Enterography/Magnetic Resonance Enterography: Is It in Prime Time?: Ah Young Kim; Clin Endosc 2012;45(3):269-273. Published online August 22, 2012; DOI: https://doi.org/10.5946/ce.2012.45.3.269

Abstract PDF PubReader ePub

Today, cross-sectional imaging modalities, such as computed tomography enterography (CTE) and magnetic resonance enterography (MRE), are particularly suited to evaluate small bowel diseases, especially Crohn's disease (CD). It is well known that CTE/MRE can provide excellent assessment of disease activity as well as the macroscopic features, extramural abnormalities, and complications of the small intestine in patients with CD. In general, CTE is considered as the first-line modality for the evaluation of suspected inflammatory bowel disease and for long-term assessment or follow-up of these patients. Because of the advantage of lack of radiation, MRE is being used more frequently, especially in children or young patients with CD.

Citations

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