The role of endoscopy in inflammatory bowel disease

Abstract

Colonoscopy plays a critical role in the management of inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD). Through endoscopic findings and histologic evaluation via biopsy, colonoscopy facilitates the diagnosis of UC and CD and enables the differentiation from other conditions such as intestinal tuberculosis and Behçet's disease. Evaluating endoscopic activity, including mucosal healing, not only aids in formulating the initial treatment plan but also provides an objective assessment of treatment response, guiding decisions on whether to continue or modify existing therapies. Furthermore, colonoscopy is instrumental in assessing postoperative recurrence, thereby informing potential treatment modifications. It also monitors for IBD-related complications, such as strictures, fistulas, and dysplasia, allowing for timely intervention. In the realm of IBD treatment, colonoscopy contributes significantly through procedures such as endoscopic resection of UC-associated dysplasia, endoscopic balloon dilation of strictures, and endoscopic fistulotomy with abscess drainage. Recent applications of artificial intelligence (AI) in colonoscopy for IBD showed promising results. In UC, AI demonstrated high accuracy in assessing both endoscopic and histologic activity. Furthermore, AI-determined endoscopic activity accurately predicted clinical outcomes, such as relapse and hospitalization. Additionally, AI-assisted endoscopy has proven accurate in differentiating between CD and intestinal tuberculosis.