Endoscopy in different diseases related to gastroenterology

Endoscopy plays an important role in the diagnosis and management of disease related to gastroenterology. It is useful to exclude other causes to differentiate between ulcerative colitis (UC) and Crohn’s disease (CD) and to define the extent and activity of inflammation. Ileocolonoscopy is used for monitoring of the disease, which in turn helps to optimize the management. It plays a key role in the surveillance of UC for dysplasia or neoplasia and assessment of post-operative CD. Capsule endoscopy and double balloon enteroscopy are increasingly used in patients with CD. Therapeutic applications relate to stricture dilatation and dysplasia resection. The endoscopist’s role is vital in the overall management of diseases.

Of the different endoscopic tools, colonoscopy remains the primary diagnostic tool. Gastroscopy, enteroscopy and endoanal ultrasound scan may be useful in the assessment of specific organ involvement in CD and to differentiate between UC and CD. Novel tools such as capsule endoscopy and double balloon enteroscopy have been playing an increasing role for small bowel Crohn’s disease assessments. Both CD and UC can be complicated by primary sclerosing cholangitis (PSC). This will focus on the role of colonoscopy in Inflammatory Bowel Disease IBD as this is by far the most important tool.

Colonoscopy technology have led to more comfortable procedures with better quality image definition like narrow band imaging, chromo endoscopy, endomicroscopy and high definition screens. Training in colonoscopy has optimised the use of this instrument for various diagnostic purposes. Colonoscopy remains the first line endoscopic investigation for suspected CD.

The use of colonoscopy as a diagnostic tool is non-contentious. Its value in disease monitoring is an evolving indication for the procedure. The thrust in this direction comes from the more recent focus on mucosal healing or reducing inflammatory activity in inflammatory bowel disease (IBD).

One of the limitations of colonoscopy is the need for oral bowel preparation to enhance adequate mucosal views. In some situations, a limited examination of the left colon with flexible sigmoidoscopy may suffice. The procedure may be undertaken following an enema or sometimes-unprepared procedure. Sigmoidoscopy provides useful information in many situations particularly, when colonoscopy is considered high risk or contraindicated e.g., acute severe colitis or fulminant colitis.

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