Enteroscopy in the diagnosis and management of Crohn disease

Crohn disease is a chronic disorder that can affect any part of the gastrointestinal tract, and is characterized by mucosal and transmural inflammation of the bowel wall. The disease most commonly involves the small bowel. Evaluation of patients with suspected Crohn disease has traditionally involved the use of ileocolonoscopy, push enteroscopy, and barium small bowel radiography. A large proportion of patients with mild small bowel disease or involvement of the mid small bowel can potentially be missed if only these tests are utilized. Enteroscopy is defined as direct visualization of the small bowel using a fiber optic or wireless endoscope. Following recent advances in technology, enteroscopy currently plays a pivotal role not only in the diagnosis of small bowel Crohn disease but also in the management of its complications, such as bleeding and strictures. Enteroscopy may have additional roles in the future, including the objective assessment of mucosal response to therapy, and surveillance for small bowel malignancy. This article focuses on the utility of enteroscopy, and its advantages and limitations in the evaluation and longterm management of Crohn disease.