Endoscopy is a valuable clinical tool for the clinician who takes care of patients with inflammatory bowel disease (IBD). The role of endoscopy in the diagnosis, management, and treatment of IBD is discussed in this review. The central role that colonoscopy plays in screening for colon cancer in patients with longstanding IBD is also addressed. 1. Introduction Endoscopy is an essential clinical tool to assist in the diagnosis and management of inflammatory bowel disease (IBD) [1]. By direct visual inspection of the intestinal mucosa used in conjunction with histology from biopsies, a diagnosis of IBD can be made. Proper use of endoscopy with biopsies also enables evaluation of other disorders that may mimic the gastrointestinal features of IBD. Once the diagnosis of IBD is made, endoscopy is performed to assess the severity and location of inflammation, and to evaluate for other disease possibilities in the midst of a flare. Response to medical treatment or surveillance for postoperative disease recurrence may also be evaluated. Finally, endoscopy is used in colon cancer surveillance in those with longstanding IBD. The role of endoscopy in these areas will be reviewed in this paper. The emerging role of wireless capsule endoscopy and endoscopic ultrasound in IBD will not be addressed. 2. Endoscopy in the Diagnosis of IBD Because IBD is a chronic lifelong condition that requires careful medical management and followup and can be associated with significant morbidity with hospitalizations and surgeries, establishing that the diagnosis is essential. Once IBD is suspected based on clinical signs and symptoms, laboratory, and/or radiology studies, endoscopy with mucosal biopsies adds considerably to the diagnosis [2, 3]. The index colonoscopy is critical in establishing the disease extent and severity. Special note must be made of the perianal area for tags, fissures, strictures, and fistula tract openings which may suggest Crohn’s disease (CD). The rectal mucosa must be carefully inspected and biopsied to evaluate for at least microscopic inflammation as involvement here is always present in ulcerative colitis (UC) [4]. Close attention to the mucosal features seen throughout the colon can help suggest IBD and even decipher between UC and CD. Sensitive endoscopic features to establish a diagnosis of CD are patchiness of the disease extent, apthous ulcers (Figure 1(a)), and cobblestoning [3] (Figure 1(b)). It is the penetrating nature into the deeper layers of the colon wall that can sometimes give the characteristic cobblestoning appearance. The discrete
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