Endoscopy

Abstract

Ileocolonoscopy is at present an essential tool for diagnosis of inflammatory bowel disease (IBD), disease assessment for prognostic purposes and therapeutic interventions. Severe endoscopic lesions are associated with higher risk since most severe endoscopic findings are associated with an increased rate of surgery and poor outcome in both Crohn’s disease and ulcerative colitis. Patients with an improvement of mucosal lesions after treatment have a good prognosis and no or slow disease progression.

Capsule endoscopy is a complimentary technique to visualize small bowel lesions. It has limited but extremely valuable indications in inflammatory bowel disease diagnosis and assessment. Upper GI endoscopy is less commonly used in the standard diagnostic workup of adult inflammatory bowel disease. However, it can be used to supplement other diagnostic techniques in selected cases.

Classification of disease activity according to endoscopic scores is essential for clinical trials as they contribute to a more objective disease assessment and allow for subsequent evaluation and grading of disease variation. The most commonly used scoring systems are Mayo endoscopic subscore and UCEIS (ulcerative colitis endoscopic index of severity) for ulcerative colitis, Rutgeerts’ score for postsurgical Crohn’s disease and CDEIS (Crohn’s disease endoscopic index of severity) and SES-CD (simplified endoscopic score for Crohn’s disease) for the assessment of ileocolonic Crohn’s disease. However, there are some limitations that have to be considered when using endoscopic scores.

Patients affected by IBD may require special nursing care as they are likely to require several endoscopic examinations during their lifetime which may result in higher anxiety. This care extends to endoscopic-specific counselling as well as bowel-cleansing prescription and sedation planning.