Enteroscopy in children and adults with inflammatory bowel disease
Inflammatory bowel disease (IBD) includes Crohn’s disease (CD), ulcerative
colitis and unclassified entities. CD commonly involves the terminal ileum and
colon but at the time of diagnosis it can be confined to the small bowel (SB) in
about 30% of the patients, especially in the young ones. Management of isolated
SB-CD can be challenging and objective evaluation of the SB mucosa is essential in
differentiating CD from other enteropathies to achieve therapeutic decisions and
to plan the follow-up. The introduction of cross-sectional imaging techniques and
capsule endoscopy (CE) have significantly expanded the ability to diagnose SB
diseases providing a non-invasive test for the visualization of the entire SB
mucosa. The main CE limitations are the low specificity, the lack of therapeutic
capabilities and the impossibility to take biopsies. Device assisted enteroscopy
(DAE) enables histological confirmation when traditional endoscopy, capsule
endoscopy and cross-sectional imaging are inconclusive and also allows
therapeutic interventions such as balloon stricture dilation, intralesional steroid
injection, capsule retrieval and more recently stent insertion. In the current review
we will discuss technical aspect, indications and safety profile of DAE in children
and adults with IBD.