Advances in endoscopy in IBD diagnostics and management.

Joana Roseira, Maria Manuela Estevinho, Beatriz Gros, Irene Marafini, Virginia Solitano, Paula Sousa, Cristina Carretero, Winnie Zou, Nasim Parsa, Aline Charabaty, Lumir Kunovsky

Journal: Best practice & research. Clinical gastroenterology 2025;78():102055

PMID: 41350091

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Abstract

Endoscopy remains an essential modality for the diagnosis, risk stratification, monitoring, and therapy of inflammatory bowel disease (IBD). Recent advances, including high-definition imaging, dye-based and virtual chromoendoscopy, and AI-assisted interpretation, improve dysplasia detection and grading of inflammatory activity, enabling treat-to-target care. In Crohn's disease, small-bowel and pan-enteric capsule endoscopy expand noninvasive assessment, while device-assisted enteroscopy allows targeted biopsy and therapy when tissue or intervention is required. Standardized scoring systems (MES/UCEIS, SES-CD, Rutgeerts) support objective follow-up, including early postoperative evaluation. Therapeutically, endoscopic balloon dilation for short strictures and advanced resection techniques (EMR/ESD) for visible dysplasia in experienced centers provide organ-sparing options; endoscopic fistula closure remains investigational. This review synthesizes contemporary trials and ECCO, ESGE, and ASGE guidance into practical algorithms that promote precise surveillance and timely intervention, positioning endoscopy as a functional, predictive, and increasingly personalized tool in IBD care.

Address: Gastroenterology Department, Unidade Local de Saúde do Algarve, Hospital de Portimão, Algarve, Portugal.; Department of Gastroenterology, Unidade Local de Saúde Gaia Espinho, Vila Nova de Gaia, Portugal; Department of Biomedicine, Unit of Pharmacology and Therapeutics, Faculty of Medicine, University of Porto, Porto, Portugal.; Department of Gastroenterology and Hepatology. Reina Sofía University Hospital. IMIBIC. University of Cordoba, Córdoba, Spain; Biomedical Research Center in Hepatic and Digestive Disease, CIBEREHD, Madrid, Spain.; Department of Systems Medicine, University of Rome Tor Vergata, Policlinico Tor Vergata, Rome, Italy. Electronic address: [email protected].; Division of Gastroenterology and Gastrointestinal Endoscopy, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy; Department of Medicine, Division of Gastroenterology, Western University, London, Canada; Departments of Medicine, Epidemiology and Biostatistics, Western University, London, Canada.; Department of Gastroenterology, Unidade Local de Saúde Viseu Dão-Lafões, Viseu, Portugal.; Gastroenterology Department, University of Navarra Clinic, Pamplona, Spain.; Division of Gastroenterology and Hepatology, Department of Internal Medicine, University of Michigan Health System, USA.; Division of Gastroenterology Hepatology and Nutrition, Department of Internal Medicine, University of Minnesota, USA.; Division of Gastroenterology, Johns Hopkins School of Medicine, Sibley Memorial Hospital, Washington, DC, USA.; 2nd Department of Internal Medicine - Gastroenterology and Geriatrics, University Hospital Olomouc, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; Department of Surgery, University Hospital Brno, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Department of Gastroenterology and Digestive Endoscopy, Masaryk Memorial Cancer Institute, Brno, Czech Republic. Electronic address: [email protected].

DOI: 10.1016/j.bpg.2025.102055

MeSH Terms: Humans, Crohn Disease, Endoscopy, Gastrointestinal, Colitis, Ulcerative, Capsule Endoscopy, Inflammatory Bowel Diseases