Front Cover

Interventional Inflammatory Bowel Disease: Endoscopic Management and Treatment of Complications

Interventional Inflammatory Bowel Disease: Endoscopic Management and Treatment of Complications

Copyright

Dedication

Contents

List of Contributors

Preface

1 - Overview of Diagnosis and Medical Treatment of Inflammatory Bowel Diseases

INTRODUCTION

EPIDEMIOLOGY

ETIOLOGY AND PATHOGENESIS

Genetic Susceptibility

Microbiota

Immune Dysregulation

Environmental Factors

DIAGNOSIS

Endoscopic Evaluation

Histologic Evaluation

Abdominal Imaging

Laboratory Evaluation

DIFFERENTIAL DIAGNOSIS

Irritable Bowel Syndrome

Microscopic Colitis

Celiac Disease

Acute Infectious Colitis

Chronic Infectious Colitis

Radiation Colitis

Ischemic Colitis

Diversion Colitis

Diverticulitis

Medication-Associated Colitis

Solitary Rectal Ulcer Syndrome

Behcet Syndrome

CLASSIFICATION OF UC

The Montreal Classification

Truelove and Witts' Severity Index

The Mayo Score

CLASSIFICATION OF CD

The Montreal Classification

The Crohn's Disease Activity Index

Crohn's Disease Endoscopic Index of Severity

The Simple Endoscopic Score for CD

MEDICAL TREATMENT OF UC

5-Aminosalicylates and Mesalamines

Corticosteroids

Immunomodulators

Cyclosporines

Biological Therapy

Other Agents

MEDICAL TREATMENT OF CD

5-Aminosalicylates and Mesalamines

Corticosteroids

Antibiotics

Immunomodulators

Biological Agents

Other Agents

SUMMARY AND RECOMMENDATIONS

REFERENCES

2 - Classification and Reclassification of Inflammatory Bowel Diseases: From Clinical Perspective

INTRODUCTION

CONVENTIONAL THEORIES OF PATHOGENESIS OF IBD

FEATURES OF CLASSIC IBD

CONVENTIONAL CLASSIFICATION OF IBD

GENETIC CONTRIBUTIONS IN DEVELOPMENT OF IBD

IBD WITH EIMS

OVERLAP OF IBD AND AIMDS

OVERLAP OF IBD AND AINDS

SPECTRUM OF IMMUNE-MEDIATED DISORDERS OF THE GUT

Pattern of Disease Extent: Small and Large Bowels

Pattern of Disease Spread: Extrinsic Versus Intrinsic

Overlap Syndrome of Immune-Mediated Disorders

Overlap Syndrome of Gut

Systemic Overlap Syndromes

Overlaps Between Chronic Gut Infection and Inflammation

TRIGGERING FACTORS FOR DE NOVO IBD: CONCEPT OF SECONDARY IBD

Fecal Microbiota Transplantation

Immunosuppressive Medications

Immune-Boosting Medications

Stem Cell and Solid Organ Transplantations

Bowel-Altering Surgery

THE TWO-HIT THEORY

RECLASSIFICATION OF IBD AND IBD-LIKE CONDITIONS

SUMMARY AND CONCLUSION

ACKNOWLEDGMENTS

REFERENCES

3 - Pathogenesis of Crohn's Disease- and Ulcerative Colitis-Related Strictures

LIST OF ABBREVIATIONS

INTRODUCTION

RISK FACTORS

PATHOGENESIS

MEDICAL THERAPY

SUMMARY AND CONCLUSION

REFERENCES

4 - Pathogenesis of Crohn's Disease-Associated Fistula and Abscess

INTRODUCTION

DEFINITION

MORPHOLOGICAL CHARACTERIZATION OF CROHN'S FISTULAS

CURRENT UNDERSTANDING OF MECHANISMS OF CROHN'S FISTULA

Epithelial-to-Mesenchymal Transition

Matrix Metalloproteinases

Cytokines in Fistula Formation

Genetic Factors in Fistula Formation

Intestinal Microbiota and Crohn's Fistula

The Role of Stricture in Crohn's Fistula

The Role of Mesentery in CD Fistula

ABSCESS IN CD

SUMMARY AND CONCLUSIONS

REFERENCES

5 - Overview of Histopathology of Ulcerative Colitis and Crohn's Disease

NORMAL HISTOLOGY OF THE BOWEL

Normal Histology of the Small Intestine

Normal Histology of the Large Intestine

OVERVIEW OF HISTOPATHOLOGY OF IBD

Histopathology of Ulcerative Colitis

Unusual Features of Ulcerative Colitis

Major Differential Diagnoses for UC

Histopathology of Crohn's Disease

Rare Variants of Crohn's Disease

Major Differential Diagnoses for CD

Indeterminate Colitis

Pathology of the Ileal Pouch and Rectal Cuff

NEOPLASIA IN IBD

Interpretation and Grading Surveillance Colonic Biopsies in Patients With IBD

Histologic Variants of IBD-Associated Dysplasia

IBD-Associated Colorectal Cancer

CD-Associated Small Bowel Adenocarcinoma

Ileal Pouch and Peripouch Neoplasia

SUMMARY AND CONCLUSIONS

REFERENCES

6 - Clinical and Endoscopic Diagnosis of IBD-Related Stricture, Fistula, and Abscess

INTRODUCTION

STRICTURE

Clinical Assessment

Conventional Endoscopy

Capsule Endoscopy

Deep Enteroscopy

Small-Caliber Endoscopy

Endoscopic Ultrasonography and Optical Coherent Tomography

FISTULA

Clinical Assessment

Conventional Endoscopy

Endoscopic Ultrasonography

ABSCESS

Clinical Assessment

Endoscopy and EUS

SUMMARY AND CONCLUSIONS

REFERENCES

7 - Role of Abdominal Imaging in the Diagnosis of IBD Strictures, Fistulas, and Postoperative Complications

INTRODUCTION

Computed Tomography Enterography

Magnetic Resonance Enterography

Ultrasonography

Comparison of Imaging Modalities

STRICTURING DISEASE

Putting It All Together: Strictures

INTRA-ABDOMINAL PENETRATING DISEASE

Intra-abdominal Abscess

Putting It All Together: Intra-abdominal Penetrating Disease

PERIANAL DISEASE

Putting It All Together: Perianal Disease

POSTOPERATIVE COMPLICATIONS

ILEAL POUCH-ANAL ANASTOMOSIS

Putting It All Together: Postoperative Complications

SUMMARY AND CONCLUSION

REFERENCES

8 - Classification of Strictures From Crohn's Disease, Ulcerative Colitis, and Inflammatory Bowel Disease-Rela ...

INTRODUCTION

DEFINITION AND SOURCE OF STRICTURE

UNDERLYING DISEASES

FEATURES OF STRICTURE

SUMMARY AND CONCLUSIONS

REFERENCES

9 - Classification of Crohn's Disease and Inflammatory Bowel Disease Surgery-Related Fistulae

INTRODUCTION

Definitions

Pathophysiology

Diagnosis

Treatment Goals and Classification of Healing

CLASSIFICATION OF PERIANAL FISTULA FROM CD (EXPANSION OF THE PARK'S CLASSIFICATION)

CLASSIFICATION OF ENTEROCUTANEOUS FISTULA

CLASSIFICATION OF ENTEROENTERIC FISTULA

CLASSIFICATION OF FISTULA FROM BOWEL TO ADJACENT NON-GI ORGANS

Gynecological Fistulas

Genitourinary Fistulas

CLASSIFICATION OF FISTULA OR LEAK FROM ANASTOMOSIS

SUMMARY AND RECOMMENDATIONS

REFERENCES

10 - Principles of Endoscopic Therapy in Inflammatory Bowel Diseases

INTRODUCTION

THE PATIENT

THE DISEASE

Development of Stricture

Development of Fistula

Development of Anastomotic Leak and Septic Complications

Development of Colitis-Associated Neoplasia

THE TARGET LESION

Strictures

Fistula

Acute and Chronic Anastomotic Leak

Colitis-Associated Neoplasia

Others

GOALS OF ENDOSCOPIC THERAPY

TIMING OF ENDOSCOPIC INTERVENTION

THE ENDOSCOPY TEAM

PREVENTION OF PROCEDURE-ASSOCIATED COMPLICATIONS

Frequency of Endoscopic Perforation

Risk Factors for Perforation

Prevention Measures of the Complications

SUMMARY AND CONCLUSIONS

ACKNOWLEDGMENTS

REFERENCES

11 - Preparation of Endoscopic Therapy for Inflammatory Bowel Diseases

INTRODUCTION

SCREENING FOR CANDIDATE PATIENTS

PRE- AND POST- PROCEDURE IMAGING

ROOM SETTINGS

BOWEL PREPARATION

ANTIBIOTIC PROPHYLAXIS

MANAGEMENT OF ANTICOAGULATION AGENTS

SEDATION AND MONITORING

INFORMED CONSENT

POSTPROCEDURE MONITORING

EQUIPMENT AND SUPPLIES

SUMMARY AND RECOMMENDATIONS

ACKNOWLEDGMENTS

REFERENCES

12 - Endoscopic Evaluation of Surgically Altered Bowel in Patients With Inflammatory Bowel Diseases

INTRODUCTION

PREPARATION

Delineation of Bowel Anatomy

Preparation of Patient

Setting

ENDOSCOPY VIA ANASTOMOSIS

ENDOSCOPY VIA STOMA

Ileostomy

Continent Ileostomy

Ileostomy in Small Bowel Transplantation

Colostomy

Mucous Fistula

Blow-Hole Colostomy

ENDOSCOPY FOR ILEAL POUCH

J Pouch

S Pouch

Continent Ileostomy

ENDOSOCPY FOR DIVERTED BOWEL

Diverted Large Bowel

Diverted Ileal Pouch

ENDOSCOPY IN STRICTUREPLASTY

ENDOSCOPY AFTER BYPASS SURGERY FOR CROHN'S DISEASE

UNIQUE CHALLENGES IN ENDOSCOPIC THERAPY

Endoscopic Treatment of Stricture

Endoscopic Treatment of Fistula

Endoscopic Treatment of Anastomotic Sinus

Endoscopic Removal of Bezoars or Foreign Body

SUMMARY AND RECOMMENDATIONS

ACKNOWLEDGMENTS

REFERENCES

13 - Endoscopic Balloon Dilation of Inflammatory Bowel Disease Strictures

INTRODUCTION

INDICATIONS

TECHNIQUES

Fluoroscopy Guidance

Retrograde Versus Antegrade Dilation

Graded Versus Nongraded Dilation and Duration of Insufflation

Short Versus Long Balloons

Visualization of Stricture During and After Dilation

Biopsy of Stricture

Distal Bowel and Anal Strictures

Special Situations for Anastomotic Strictures

Stricture With Concurrent Fistula

Combined With Other Treatment Modalities

FACTORS ASSOCIATED WITH EFFICACY OF EBD

Non-Crohn's Versus Crohn's Stricture

The Length of Stricture

Primary Versus Secondary Strictures

The Presence of Prestenonic Lumen Dilation

Size of Balloon

Concurrent Inflammation and Systemic Treatment of Inflammation

Intralesional Injection of Corticosteroids or Anti-TNF Biologics

SUMMARY AND RECOMMENDATIONS

ACKNOWLEDGMENTS

REFERENCES

14 - Endoscopic Stricturotomy

INTRODUCTION

THE RATIONALE FOR ENDOSCOPIC STRICTUROTOMY

Advantages of Endoscopic Stricturotomy

Limitations of Endoscopic Stricturotomy

Choice Between Endoscopic Stricturotomy and Balloon Dilation

TECHNIQUES

Endoscopic Electroincision

Endoscopic Electrocauterization

Combined Endoscopic Therapy

PROCEDURE-ASSOCIATED COMPLICATIONS AND PRECAUTIONS

SUMMARY AND CONCLUSIONS

REFERENCES

15 - Endoscopic Stent Treatment for Crohn's Disease

INTRODUCTION

TYPES OF STENTS

Self-expanding Metal Stents

Biodegradable Stents

STENT TREATMENT OF STRICTURES

STENT TREATMENT OF ANASTOMOTIC LEAKS AND FISTULA IN CD

SUMMARY AND CONCLUSIONS

REFERENCES

16 - Endoscopic Therapy for the Treatment of Inflammatory Bowel Disease-Related Fistula, Sinus, and Abscess

INTRODUCTION

PRINCIPLES OF ENDOSOCPIC TREATMENT OF FISTULA, SINUS, AND ABSCESS

ENDOSCOPIC FISTULOTOMY

ENDOSCOPIC SINUSOTOMY

ENDOSCOPIC INJECTION OF FILLING AGENTS

Fibrin Glue

Plugs

Topical Therapy of Stromal Cells or Stem Cells

ENDOSCOPIC DRAINAGE OF ABSCESS

Pigtail Stent

Seton and Mushroom Catheter Drainage

ENDOSCOPIC CLOSURE OF FISTULA AND ANASTOMOTIC LEAK

Through-the-Scope Clip

Over-the-Scope Clip

Endoscopic Suturing

Metal Stent Covering

ENDOSCOPIC ULTRASOUND-GUIDED TREATMENT OF PERIANAL FISTULA

COMMON ENDOSCOPY PROCEDURE-ASSOCIATED COMPLICATIONS AND THEIR PREVENTION

SUMMARY AND CONCLUSIONS

ACKNOWLEDGMENTS

REFERENCES

17 - Endoscopic Evaluation and Management of Perianal Crohn's Disease

INTRODUCTION

ENDOSCOPIC EVALUATION

Endoscopic Ultrasound Evaluation

Endoscopic Ultrasound Evaluation Compared to Other Imaging Modalities

Endoscopic/Endoscopic Ultrasound-Guided Therapy

INTERVENTIONAL USES OF ENDOSCOPY FOR PERIANAL FISTULAS

Treatment Algorithm (Fig. 17.4)

SUMMARY AND CONCLUSIONS

REFERENCES

18 - Stem-Cell Therapy in Fistulizing Perianal Crohn's Disease

INTRODUCTION

GENERAL ASPECTS OF STEM-CELL THERAPY

STEM-CELL THERAPY IN FISTULIZING PERIANAL CROHN'S DISEASE

COMBINATION THERAPY

STEM-CELL THERAPY IN NON-CROHN DISEASE FISTULA

SUMMARY AND CONCLUSIONS

REFERENCES

19 - Endoscopic Detection and Removal of Colitis-Associated Dysplasia

INTRODUCTION

SURVEILLANCE TECHNIQUES

THE SCENIC INTERNATIONAL CONSENSUS

IMAGE-ENHANCED ENDOSCOPY

High-Definition White Light Is Superior to Standard-Definition White-Light Colonoscopy

Chromoendoscopy With Targeted Biopsy

Chromoendoscopy Technique

Superiority of Chromoendoscopy With Targeted Biopsy

Morphologic Description and Endoscopic Characterization of Inflammatory Bowel Disease Dysplasia

PRINCIPLES OF ENDOSCOPIC REMOVAL OF COLITIS-ASSOCIATED NEOPLASIA

ENDOSCOPIC MUCOSAL RESECTION

ENDOSCOPIC SUBMUCOSAL DISSECTION

Delineating Margins

Marking the Lesion

Mucosal Incision and Submucosal Dissection

Distal Attachments (Caps)

Endoscopic Submucosal Dissection Knives

Coagulation Devices

COMPLICATIONS OF ENDOSCOPIC RESECTION

Bleeding

Perforation

SUMMARY AND CONCLUSIONS

REFERENCES

20 - Endoscopic Management of Hepatobiliary Complications of Inflammatory Bowel Disease

INTRODUCTION

DIAGNOSIS OF PRIMARY SCLEROSING CHOLANGITIS

Definition

Primary Sclerosing Cholangitis and Inflammatory Bowel Disease

Diagnostic Criteria for Primary Sclerosing Cholangitis

Endoscopic Retrograde Cholangiopancreatography and Magnetic Resonance Cholangiopancreatography for Primary Sclerosing Chola ...

ENDOSCOPIC TREATMENT OF PRIMARY SCLEROSING CHOLANGITIS

Endoscopic Retrograde Cholangiopancreatography With Stenting

Endoscopic Retrograde Cholangiopancreatography With Balloon Dilatation and Stenting

Endoscopic Retrograde Cholangiopancreatography With Balloon Dilatation

DIAGNOSIS OF CHOLANGIOCARCINOMA AND INDETERMINATE STRICTURES

Evaluation of Cholangiocarcinoma

Evaluation of Indeterminate Biliary Stricture

Advanced Cytological Analysis of Biliary Brushing Specimen

Intraductal Ultrasound

EUS With Fine Needle Aspiration

Probe-Based Confocal Laser Endomicroscopy

SUMMARY AND CONCLUSIONS

REFERENCES

21 - Overview of Surgical Therapy for Crohn's Disease

INTRODUCTION

MEDICAL TREATMENT OF CROHN'S DISEASE

INDICATIONS FOR SURGERY

PREOPERATIVE CONSIDERATIONS

THE INITIAL OPERATION

Disease Recurrence

Resection Margin

Type of Anastomosis

Strictureplasty

SURGICAL TREATMENT OF PERIANAL DISEASE

STOMA INDICATION AND CONSTRUCTION

Isolated Proctitis

Isolated Perianal Disease

Diversion Following an Anastomosis

Surveillance Following Surgery

SUMMARY AND CONCLUSIONS

REFERENCES

22 - Multidisciplinary Approach to Stricturing Crohn's Disease: Medical Versus Endoscopic Versus Surgical Therapy

INTRODUCTION

MEDICAL THERAPY

Efficacy of Medical Therapy for Stricturing CD

Concern of Medical Therapy for Stricturing Crohn's disease

ENDOSCOPIC THERAPY

Endoscopic Balloon Dilation

Endoscopic Stricturotomy

Other Endoscopic Treatment Modalities

Endoscopy-Associated Complications

SURGICAL THERAPY

Surgical Bowel Resection and Anastomosis

Stricturoplasty

Risk Factors for Postoperative Recurrence of Bowel Resection or Stricturoplasty

Surgery-Associated Complications

SUMMARY AND RECOMMENDATION

ACKNOWLEDGMENTS

REFERENCES

23 - Overview of Surgical Treatment for Ulcerative Colitis

INTRODUCTION

TOTAL PROCTOCOLECTOMY WITH PERMANENT ILEOSTOMY

RESTORATIVE PROCTOCOLECTOMY WITH ILEAL POUCH-ANAL ANASTOMOSIS

Deciding Among Pouch Configurations

Stapled Versus Handsewn (Mucosectomy) Anastomosis

Revisional Pouch Surgery

SUBTOTAL COLECTOMY WITH END ILEOSTOMY AND HARTMANN POUCH

COLECTOMY WITH ILEORECTAL ANASTOMOSIS

CONTINENT ILEOSTOMY (KOCK POUCH)

SUMMARY AND CONCLUSIONS

REFERENCES

24 - Common Complications of Surgery for Crohn's Disease and Ulcerative Colitis

INTRODUCTION

SURGICAL SITE INFECTION (WOUND INFECTION)

ABSCESS AND SEPSIS

Postoperative Intraabdominal Septic Complications in Crohn's Disease

Postoperative Intraabdominal Septic Complications in Restorative Proctocolectomy With Ileal Pouch

ANASTOMOTIC HEMORRHAGE

Postoperative Anastomotic Bleeding Surgery for CD

Postoperative Ileal Pouch Bleeding

ANASTOMOTIC LEAK, FISTULA, AND SINUS

Postoperative Anastomotic Leaks in CD

Ileal Pouch Leak

Ileal Pouch Sinus

Pouch Fistula

ANASTOMOTIC STRICTURES

Postoperative Anastomotic Stricture in Crohn's Disease

Ileal Pouch Strictures

SUMMARY AND CONCLUSIONS

REFERENCES

25 - Postoperative Crohn's Disease Recurrence and Role of Endoscopy

INTRODUCTION

ENDOSCOPY IN GUIDING MANAGEMENT OF POSTOPERATIVE CROHN'S DISEASE

The American Gastroenterological Association

European Crohn's and Colitis Organisation

MEDICAL MANAGEMENT OF POSTOPERATIVE CROHN'S DISEASE

ENDOSCOPIC MANAGEMENT OF ANASTOMOTIC STRICTURE

SUMMARY AND CONCLUSIONS

REFERENCES

26 - Diagnosis and Treatment of Inflammatory Bowel Disease-Associated Bleeding

INTRODUCTION

FREQUENCY

ETIOLOGY AND RISK FACTORS

DIAGNOSIS

MEDICAL TREATMENT

ENDOSCOPIC TREATMENT

Topical Therapy

Polypectomy

Endoscopic Cauterization

Endoscopic Clipping

INTERVENTIONAL RADIOLOGY TREATMENT

SURGICAL TREATMENT

SUMMARY AND CONCLUSIONS

ACKNOWLEDGMENTS

REFERENCES

27 - Endoscopic Treatment of Bezoars and Foreign Bodies in Patients With Inflammatory Bowel Disease

INTRODUCTION

RISK FACTORS FOR BEZOARS

CLINICAL PRESENTATIONS

DIAGNOSIS

TREATMENT

Medical Therapy

Endoscopic Therapy

Surgical Therapy

SUMMARY AND RECOMMENDATIONS

REFERENCES

28 - Fecal Microbiota Transplantation as Therapy for Inflammatory Bowel Disease

INTRODUCTION

HUMAN MICROBIOTA AND INFLAMMATORY BOWEL DISEASE

BACKGROUND ON FECAL MICROBIOTA THERAPY

FECAL MICROBIOTA TRANSPLANTATION AS THERAPY FOR INFLAMMATORY BOWEL DISEASE

SUMMARY AND RECOMMENDATIONS

REFERENCES

29 - Damage Control: Management of Procedure-Associated Complications

INTRODUCTION

IATROGENIC PERFORATION

Causes, Risk Factors, and Mechanisms

Diagnosis of Endoscopic Perforation

Classification of Endoscopic Perforation

Consequences of Endoscopic Perforation

Conservative Management With Observation

Endoscopic Management

Surgical Management

Management Algorithm

IATROGENIC BLEEDING

Risk Factors of Endoscopic Bleeding

Diagnosis of Endoscopic Bleeding

Classification of Endoscopic Bleeding

Conservative Management With Observation

Endoscopic Management

Interventional Radiology

Surgical Management

Management Algorithm

POSTPROCEDURE ABDOMINAL DISTENTION AND ILEUS

STRICTURE RESULTING FROM ENDOSCOPY THERAPY

SUMMARY AND CONCLUSIONS

ACKNOWLEDGMENTS

REFERENCES

Index

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

P

R

S

T

U

W

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