Role of new endoscopic techniques in inflammatory bowel disease management: Has the change come?

Despite significant therapeutic progress in recent years,inflammatory bowel disease(IBD),which includes Crohn’s disease and ulcerative colitis,remains a challenge regarding its pathogenesis and long-term complications.New concepts have emerged in the management of this disease,such as the"treat-totarget"concept,in which mucosal healing plays a key role in the evolution of IBD,the risk of recurrence and the need for surgery.Endoscopy is essential for the assessment of mucosal inflammation and plays a pivotal role in the analysis of mucosal healing in patients with IBD.Endoscopy is also essential in the detection of dysplasia and in the identification of the risk of colon cancer.The current surveillance strategy for dysplasia in IBD patients indicates white-light endoscopy with non-targeted biopsies.The new chromoendoscopy techniques provide substantial benefits for both clinicians and patients.Narrow-band imaging(NBI)has similar rates of dysplastic lesion detection as whitelight endoscopy,and it seems that NBI identifies more adenoma-like lesions.Because it is used instinctively by many endoscopists,the combination of these two techniques might improve the rate of dysplasia detection.Flexible spectral imaging color enhancement can help differentiate dysplastic and non-dysplastic lesions and can also predict the risk of recurrence,which allows us to modulate the treatment to gain better control of the disease.The combination of noninvasive serum and stool biomarkers with endoscopy will improve the monitoring and limit the evolution of IBD because it enables the use of a personalized approach to each patient based on that patient’s history and risk factors.

Capsule endoscopy:Current status and role in Crohn's disease

Capsule endoscopy(CE) has proved to be an important non-invasive tool for diagnosis and monitoring Crohn's disease patients.It has the advantage of excellent visualization of digestive tract mucosa,a good tolerability and safety in well-selected patients.The risk of retention can be diminished by good selection of patients using imaging techniques and by the use of patency capsule.The aim of a capsule examination is not only an early diagnosis but also a very good stratification of prognosis,thus directing the treatment strategy for either a step up or top-down approach and also permitting the optimization of the treatment depending on the findings.When symptoms and biomarkers point to a change in the disease's activity we can either adjust the treatment directly as recommended in CALM study or choose in selected patients to visualize the digestive mucosa through a CE and take a decision afterwards.The appearance of the new capsule from Medtronicthe Pillcam Crohn's might be an important step forward in diagnosis,evaluating disease extent,the severity of the disease,prognosis,management in a treat to target approach,with treatment modifications according to the data from CE examination.Serial examinations in the same patient can be compared and a more objective evaluation of the lesions modification from one exam to another can be performed.We present the latest developments and current status and evidence that in selected patients capsule can be a tool in a treat to target approach.