Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 28, 2021; 27(20): 2521-2530
Published online May 28, 2021. doi: 10.3748/wjg.v27.i20.2521
Evolving role of endoscopy in inflammatory bowel disease: Going beyond diagnosis
Paulina Núñez F, Noa Krugliak Cleveland, Rodrigo Quera, David T Rubin
Paulina Núñez F, Rodrigo Quera, Department of Gastroenterology, Inflammatory Bowel Disease Program, Clinica Universidad de los Andes, Santiago 7620157, RM, Chile
Paulina Núñez F, Department of Gastroenterology, Hospital San Juan de Dios, Santiago 8350488, RM, Chile
Noa Krugliak Cleveland, David T Rubin, University of Chicago Medicine Inflammatory Bowel Disease Center, Chicago, IL 60637, United States
Author contributions: All authors equally contributed to this review with the conception and design of the study, literature review and analysis, drafting and critical revision and editing, and approval of the final version.
Conflict-of-interest statement: Rubin DT has received grant support from Takeda; and has served as a consultant for Abbvie, Altrubio, Allergan Inc., Arena Pharmaceuticals, Bellatrix Pharmaceuticals, Boehringer Ingelheim Ltd., Bristol-Myers Squibb, Celgene Corp/Syneos, Connect BioPharma, GalenPharma/Atlantica, Genentech/Roche, Gilead Sciences, InDex Pharmaceuticals, Ironwood Pharmaceuticals, Iterative Scopes, Janssen Pharmaceuticals, Lilly, Materia Prima, Pfizer, Prometheus Biosciences, Reistone, Takeda, and Techlab Inc. Quera R and Nuñez F Phave received support for attending meetings from Janssen.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: David T Rubin, MD Chief, Section of Gastroenterology, Hepatology and Nutrition.University of Chicago Medicine Inflammatory Bowel Disease Center, 5841 S. Maryland Ave., MC4076, Room M410, Chicago, IL 60637, United States.
Received: January 22, 2021
Peer-review started: January 22, 2021
First decision: March 29, 2021
Revised: April 11, 2021
Accepted: April 26, 2021
Article in press: April 26, 2021
Published online: May 28, 2021

Inflammatory bowel disease, encompassing Crohn’s disease (CD) and ulcerative colitis, are chronic immune-mediated inflammatory bowel diseases (IBD) that primarily affect the gastrointestinal tract with periods of activity and remission. Large body of evidence exist to strengthen the prognostic role of endoscopic evaluation for both disease activity and severity and it remains the gold standard for the assessment of mucosal healing. Mucosal healing has been associated with improved clinical outcomes with prolonged remission, decreased hospitalization, IBD-related surgeries and colorectal cancer risk. Therefore, endoscopic objectives in IBD have been incorporated as part of standard care. With the known increased risk of colorectal cancer in IBD, although prevention strategies continue to develop, regular surveillance for early detection of neoplasia continue to be paramount in IBD patients’ care. It is thanks to evolving technology and visualization techniques that surveillance strategies are continuously advancing. Therapeutic endoscopic options in IBD have also been expanding, from surgery sparing therapies such as balloon dilation of fibrostenotic strictures in CD to endoscopic mucosal resection of neoplastic lesions. In this review article, we discuss the current evidence on the use of endoscopy as part of standard of care of IBD, its role in surveillance of neoplasia, and the role of interventional endoscopic therapies.

Keywords: Inflammatory bowel disease, Endoscopy, Crohn’s disease, Ulcerative colitis, Therapeutic endoscopy, Surveillance

Core Tip: Endoscopy is critical to the diagnosis of inflammatory bowel diseases (IBD) and is increasingly being used for disease monitoring and management to achieve the therapeutic goal of mucosa healing. In this review, we focus on the utility of endoscopy as a therapeutic objective, in disease monitoring, and in surveillance to detect and prevent neoplasia. We will also discuss the evolving role of endoscopic therapeutic interventions in IBD.