Preparation of Endoscopic Therapy for Inflammatory Bowel Diseases

Introduction

In the past decade, endoscopic therapy has emerged as a valid alternative in the treatment of inflammatory bowel disease (IBD) to medical and surgical therapy, as it is more effective than medical therapy and less invasive than surgical surgery for IBD-associated stricture and maybe Crohn's disease (CD)–related fistula. Endoscopic therapy has served as a bridging treatment modality between the medical and surgical therapy. Endoscopic therapy in IBD should be performed in experienced hands with main goals to avoid or space out the need for surgery. In this chapter, we discuss the preparation of endoscopic management for CD or ulcerative colitis-associated complications based on current literature and our vast experiences in a tertiary Interventional Inflammatory Bowel Disease (IBD) Unit at the Cleveland Clinic Foundation.

Screening for Candidate Patients

Not all patients with IBD-associated strictures, fistula, or surgical anastomotic leaks are eligible for endoscopic therapy. Therapeutic endoscopy should be avoided or postponed in patients with one of the following conditions: (1) malnutrition or severe comorbidities and being poor candidate for rescuing surgical intervention in case of endoscopy complications; (2) emergency setting; (3) concurrent use of immunosuppressive agents, such as corticosteroids and antitumor necrosis factor (TNF); (4) pregnancy; and (5) bleeding disorders or concurrent use of anticoagulations.

Routine history and physical examination should be performed before the procedure. Female patients at reproductive age may be screened for pregnancy.

Routine laboratory testing is useful for evaluating the risk of scheduled procedures, and for assisting in the selection of the appropriate endoscopic techniques. The American Society for Gastrointestinal Endoscopy (ASGE) recommended that preprocedural testing, such as complete blood counts, basic metabolic panel, coagulation tests, and electrocardiography, should be done selectively in indicated patients based on the medical history, physical examination, and procedure risk factors.

Defibrillator must be turned off during endoscopic electroincision and electrocauterization. The patient will need to be continuously monitored with a portable defibrillator.