Old Problems and New Challenges Recent Advances Of Endoscopy In Inflammatory Bowel Diseases = Old Problems and New Challenges Recent Advances Of Endoscopy In Inflammatory Bowel Diseases

다국어 초록 (Multilingual Abstract)

Endoscopy plays a key role for the diagnosis and treatment in inflammatory bowel disease (IBD). The single most valuable tool for distinguishing the different forms of IBD is a complete ileocolonoscopy with mucosal biopsy. Endoscopic localization of disease not only aids in determining prognosis and appropriateness of medical therapies but also help decision making in those undergoing surgical therapy. In addition, obstructive symptoms caused by benign fibrotic strictures can be treated adequately by endoscopic balloon dilation. Epidemiological studies have demonstrated an increased risk of colorectal cancer in patients with both UC and colonic CD. In terms of cancer surveillance, colonoscopy is considered currently to be the gold standard. Published guidelines recommend that 2∼4 biopsies should be taken every 10 cm in the colorectum, rendering 20∼50 biopsies per examination. However, standard colonoscopy is far from perfect and may miss significant numbers of small lesions. Furthermore, it is very time-consuming and laborious. To overcome those problems, there have been many efforts to reduce biopsies taken and time of examinations through various novel techniques, including chromoendoscopy with or without magnification, fluorescence endoscopy, narrow band inaging (NBI), optical coherence tomography (OCT) and confocal laser endomicroscopy. Until recently the only way to evaluate the small bowel mucosa in a patient with CD was by barium small bowel radiographs and intubation of the distal terminal ileum. Both WCE (wireless capsule endoscopy) and DBE (double balloon enteroscopy) allow light to be used in the inspection of small bowel and may replace previous radiological methods. WCE is more convenient than DBE for probing small bowel mucosal changes, but only DBE allows biopsy to be obtained in deep small bowel studies, and these two examinations can be considered complementary. Because of recently invented technologies, that might be widely available in the near future, endoscopy will play an increasingly important role in the management of IBD.