GASTROENTEROLOGY ARTICLE OF THE WEEK
May 11, 2006
ASGE. ASGE guideline: endoscopy in the diagnosis and treatment of inflammatory bowel disease. Gastrointest Endosc 2006;63:558-565.
1, Biopsy in IBD
a. biopsies should be obtained both from normal and abnormal mucosa and labeled accordingly.
b. the presence of granulomas suggest Crohn’s disease, granulomas are found in 80-85% of biopsies from Crohn’s patients
c. In Crohn’s disease, UGI biopsies are more likely to show granulomas than colonic biopsies
d. The absence of crypt branching or goblet cell mucus depletion suggests an acute infections process rather than chronic IBD
2. Polyps in IBD
a. Polyps developing in an non-inflamed area of the colon that appear not to be inflammatory should be completely excised and the mucosa around the polyp should be biopsied and placed in a separate container to detect dysplasia
b. A sessile polyp in an area of active inflammation should be removed using saline-assisted polypectomy
c. Colectomy should be considered if a polyp removed from a non-inflamed area is determined to be an adenoma with low grade dysplasia, biopsies around the polyp showed no dysplasia.
d. Colectomy should be considered if a pedunculated polyp removed from an area of inflammation is found to be an adenoma with low grade dysplasia and biopsies around the polyp site show dysplasia.
e. Tattooing should be considered when polyps are removed from inflamed areas of the colon.
True or False
3. The findings of a cecal patch of inflammation in a patient with left sided ulcerative colitis does not indicate that Crohn’s is the likely diagnosis
4. Patients with Ulcerative colitis and multifocal low grade dysplasia should undergo repeat colonoscopy in 1 year
5. Endoscopic exam with biopsies can differentiate IBD from other colitides including drug-induced and infections
6. After surgery for Crohn’s disease, endoscopic relapse typically precedes symptomatic relapse, repeat colonoscopy 6-12 months post-op may be considered to select patients in need for therapy
7. A colonoscopy showing segmental colonic inflammation in a patient undergoing treatment for presumed U.C., indicates that Crohn’s is the likely diagnosis
8. A stricture found in a patient with ulcerative colitis is considered malignant until proven otherwise.
9. In ulcerative colitis, extent of disease should be established based on histology rather than endoscopic findings
10. Patients with UC or Crohn’s involving > 1/3 of the colon should undergo surveillance colonoscopy every 1 to 2 years starting 8 years after diagnosis.
11. A stricture found in a patient with Crohn’s disease is likely to be benign, however multiple biopsies should be obtained.
12. Total colectomy should be recommended to a patient with ulcerative colitis (pancolitis) in remission who is found to have an adenoma in the cecum and multifocal low grade dysplasia in the ascending and transverse colon.