Exabis Library

Endoscopy Characterisation of Dysplastic Lesions in IBD

Inflammatory bowel disease (IBD), including Crohn’s disease (CD) and ulcerative colitis (UC), are chronic, progressive, disabling condition. Since strategies targeting the control of symptoms do not significantly change the natural course of the diseases, mucosal healing has become the therapeutic goal to prevent disease recurrence and structural damage. However, frequent colonoscopies (CS) are expensive, invasive, and not well tolerated by patients, thus non-invasive tools for assessment and monitoring are strongly needed.

Bowel ultrasound (US) is a well-tolerated, non-invasive, patient friendly, cheap, easy-to-use tool to manage IBD patients in clinical practice. In addition, its ability to be performed as point-of-care bowel US may drastically change frequency of the assessment of treatment response, speeding the clinical decision-making process

This presentation aims to review the evidence for the use of bowel US, alternatively to CS, for the assessment and monitoring of disease activity in IBD.

Technical features of Entero-MRI (E-MRI) will be briefly illustrated from basic to advanced sequences.
Imaging findings of ileal Crohn’s disease will be reviewed in this talk with emphasis on their clinical meaning according to literature and Ecco/Esgar  statements.
After this talk participants of the workshop will be able to approach in a critical manner E-MRI studies and MRI structured reports giving a guide to appreciate those findings more relevant in clinical practice in patient management.
Emphasis will be given in the definition of relevant findings such as strictures, penetrating lesions, edema and fibrosis of bowel wall.
Criteria to assess inflammation activity as well as  MR scores of activity will be illustrated.
Strength and weak points  of E-MRI will be discussed

Educational objectives: 

1. To understand the risk management prior to surgery and how to prevent enterocutaneous fistulas
2. To briefly understand the pre- and peroperative management of enterocutaneous fistulas

1) over view of aetiology of IBD
2) discussion of diet as a precipitant: epidemiology, animal models and human studies
3) review evidence that dietary modification may impact IBD onset and natural history

Introduction:

The histologic examination of endoscopic biopsies or resection specimens remains a key step in the work-up of affected inflammatory bowel disease (IBD) patients and can be used for diagnosis and differential diagnosis, particularly in the differentiation of UC from CD and other non-IBD related colitides. The introduction of new treatment strategies in inflammatory bowel disease (IBD) interfering with the patients' immune system may result in mucosal healing, making the pathologists aware of the impact of treatment upon diagnostic features. The European Crohn's and Colitis Organisation (ECCO) and the European Society of Pathology (ESP) jointly elaborated a consensus to establish standards for histopathology diagnosis in IBD. The consensus endeavors to address: (i) procedures required for a proper diagnosis, (ii) features which can be used for the analysis of endoscopic biopsies, (iii) features which can be used for the analysis of surgical samples, (iv) criteria for diagnosis and differential diagnosis, and (v) special situations including those inherent to therapy. Questions that were addressed include: how many features should be present for a firm diagnosis? What is the role of histology in patient management, including search for dysplasia? Which features if any, can be used for assessment of disease activity? The statements and general recommendations of this consensus are based on the highest level of evidence available, but significant gaps remain in certain areas.

This ECCO Topical Review of the European Crohn’s and Colitis Organisation [ECCO] focuses on the role of environmental factors with respect to the development of inflammatory bowel disease [IBD] as well as their influence on the course of established IBD. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.

This ECCO topical review of the European Crohn’s and Colitis Organisation [ECCO] focuses on the epidemiology, pathophysiology, diagnosis, management and outcome of the two most common forms of inflammatory bowel disease, Crohn’s disease and ulcerative colitis, in elderly patients. The objective was to reach expert consensus to provide evidence-based guidance for clinical practice.