Endoscopy In Inflammatory Bowel Disease An Issue Of Gastrointestinal Endoscopy Clinics Of North America

The field of inflammatory bowel disease has evolved in many ways. The first has been the revolution in medical therapy for the disease. With the advent of biologic therapy, the aspirational goal of therapy has become mucosal healing. These medications have also made it possible to avoid or delay surgery for ulcerative colitis and Crohn's disease. Although non-invasive strategies such as MR or CT enterography or stool-based assays are helpful, they have not been able to replace the prognostic information provided by endoscopy. Simultaneously, the quality and spectrum of tools available to perform endoscopy has widened. High resolution endoscopes are now the norm and are nearly as good as chromoendoscopy for identifying dysplasia in ulcerative colitis patients. Most gastroenterologists also perform dilations but do not generally do this for patients with IBD. Finally, newer devices such as enteroscopes, endoscopic ultrasound, and endomicroscopes are being incorporated into the algorithms to diagnose and treat complications of IBD. This issue highlights all of these advances by the experts in their fields.

Dr. Charles Lightdale selected top expert Dr. Charles Lichtiger to serve as Guest Editor for this issue of Gastrointestinal Endoscopy Clinics devoted to Inflammatory Bowel Disease. The issue uniquely addresses the questions that arise when trying to treat and diagnose IBD. Further, it provides information on what the future might look like for endoscopists. Articles are devoted to the following topics: The Era of Anti-TNF’s is Over: What do we know, don’t know, and yearn to know; Prognostigating the Course of IBD- Is it an art or Science; Treat to Target: What is Target and How do we Treat; The Microbiota and the Immune Response: What is the Chicken and What is the Egg; The Role of the Radiologist in Determining Disease Severity; Capsule Endoscopy and Small Bowel Enteroscopy: Have they Rendered the Radiologist Obsolete; Dysplasia Surveillance; Endoscopic Submucosal Dissection: Are We Transitioning to it; Strictures in Crohn’s Diagnosis and UC: Is there a role for the gastroenterologist, endoscopist, or is it always the surgeon; Endoscopy in the Postoperative Patient with CD or UC: Does it Translate to better Outcomes; The Role of Histology in Determining Disease Activity, Treatment, and Prognosis: Are we there yet; Perianal Disease: The role of Endoscopy, EUS, EUA, Laser Therapy, Sealing Agents, and Stem Cells; Imaging of Mucosal Inflammation: Current Developments and Future Perspectives for IBD; Surgery in IBD: Is there any need for Open Procedures. Readers will come away with a state-of-the-art understanding about the current and future clinical picture for endoscopy in IBD.

Endoscopic access to the small bowel has advanced significantly since the introduction of video capsule endoscopy and deep enteroscopy in early 2000. Other major advances have occurred in imaging modalities involving computed tomography and magnetic resonance studies. Due to these advances, the recent 2015 ACG guideline changed the terminology from “obscure to “small bowel bleeding because the majority of cases now can be found to have a small bowel source. The improvements in technology have advanced our ability to visualized vascular findings, inflammatory lesions, and small bowel neoplasms. Articles in this issue are devoted to these improvements in technology.

In this issue of Gastrointestinal Endoscopy Clinics of North America, guest editor Dr. Catharine M. Walsh brings her considerable expertise to the topic of Pediatric Endoscopy. Since its inception in the early 1980s, pediatric endoscopy has seen dramatic innovations in both diagnostic procedures and advanced procedures that are increasingly being performed by pediatric trained endoscopists. In this issue, top experts bring you fully up to date with recent advances in this fast-changing field. Contains 14 practice-oriented topics including pediatric unsedated transnasal endoscopy; tools for improving quality in pediatric endoscopy; artificial intelligence in pediatric endoscopy; advances in endoscopy for pediatric inflammatory bowel disease; and more. Provides in-depth clinical reviews on pediatric endoscopy, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Dr Roy Soetikno and Dr Tonya Kaltenbach are the editors for this issue of Gastrointestinal Endoscopy Clinics of North America, which is devoted to the improved detection and management of early neoplasia in inflammatory bowel disease. An important aspect of Dr Soetikno’s outstanding career has been the bridging of endoscopic methods between Japan and the United States. Endoscopists in Japan have a better record of detecting subtle flat GI lesions. From the earliest days of endoscopy, it is fair to say that Japanese endoscopists have emphasized visual identification, analysis, and photo documentation of small GI lesions. The colon has been no exception. Dr Soetikno has incorporated these techniques, which have become increasingly feasible with steady improvement in modern digital endoscopes. Identifying small flat premalignant lesions and early cancers in patients with colitis can be lifesaving. Dr Soetikno and Dr Kaltenbach have edited an extraordinary issue of the Gastrointestinal Endoscopy Clinics of North America devoted to teaching and promulgating these methods, including an extensive photo atlas, which should be an invaluable resource for all academic specialists and practicing gastroenterologists.

Inflammatory Bowel Disease is reviewed extensively in this important Surgical Clinics of North America issue. Articles include: Inflammatory Bowel Disease: Historical Perspective, Epidemiology and Risk Factors; Diagnostic Modalities for Inflammatory Bowel Disease: Serologic Markers and Endoscopy; Diagnostic Modalities for Inflammatory Bowel Disease: Radiologic Imaging; Medical Therapy for Inflammatory Bowel Disease; Crohn's Disease of the Foregut and Small Intestine; Crohn's Disease of the Colon, Rectum and Anus; Indications and Options for Surgery in Ulcerative Colitis; Challenges in the Medical and Surgical Management of Chronic Inflammatory Bowel Disease; Extraintestinal Manifestations of Inflammatory Bowel Disease; Colorectal Neoplasia and Inflammatory Bowel Disease; Nutritional Support of the Inflammatory Bowel Disease Patient; Psychosocial Support of the Inflammatory Bowel Disease Patient; Genetics and Pathogenesis of Inflammatory Bowel Disease; and more!

In this issue, guest editors bring their considerable expertise to this important topic. Provides in-depth reviews on the latest updates in the field, providing actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create these timely topic-based reviews.

The Guest Editors have focused on methods of diagnosing and evaluating IBD to help guide optimal treatment to maximize clinical outcomes and minimize risks. Authors have provided state-of-the-art updates with practical information/guidelines/algorithms and cutting-edge data for incorporation into practice. The first set of articles deals with endoscopy: its role in diagnosis and monitoring IBD; the growing importance of chromoendoscopy in IBD surveillance exams; assessment of post-operative recurrence; and finally the emerging role of capsule endoscopy. The second section focuses on specific scenarios that IBD physicians encounter frequently: health maintenance in IBD focusing on proper vaccinations; the growing problem of Clostridium difficile in IBD; assessment of pouch problems; optimal evaluation of perianal disease; the state of the art in using thiopurines including use of allopurinol to optimize metabolites and optimizing the use of infliximab by measuring levels and antibodies to infliximab; factors to consider in choosing monotherapy versus combination therapy and communication of risk/benefit to patients; and finally disability assessment in IBD. The third and final section highlights noninvasive methods to evaluate IBD: clinical predictors of aggressive or disabling disease; the evolving role of specific antibodies in diagnosing, subtyping and most recently prognosticating in IBD; stool markers (calproctectin and lactoferrin) for evaluating and monitoring IBD; the growing role of imaging modalities with emphasis on MR enterography and CT enterography; and finally, the genetics of IBD and the potential role of genetic testing in the diagnosis/prognosis and tailoring of therapy.