Principles and techniques of interventional IBD: Endoscopic management of complications

Natural history of inflammatory bowel disease (IBD) determines that the majority of the patients will develop structural complications, such as strictures and fistulas. Medical therapy offers limited effiacy for these complications. Surgical invervention, however, suffers from frequent postoperative complications and disease recurrence.  Interventional IBD (or therapeutic endoscopy has an expanding role in the treatment of ulcerative colitis and Crohn's disease and surgical complications. Endoscopic therapy has been explored and used in the management of strictures, fistulas/abscesses, colitis-associated neoplasia, and post-surgical ileus, bleeding, acute or chronic leaks, and anastomotic strictures. The endoscopic therapeutic modalities include balloon dilation, stricturotomy, stent placement, fistulotomy, fistula injection and clipping, sinusotomy, endoscopic mucosal resection, and endoscopic submucosal dissection, and bleeding control. Endoscopic therapy provides more effective than medical treatment and less invasive than surgery for the structural complications related to IBD or IBD surgery.  Effective and safe performance of endoscopic therapy in patients with immunosupressives-loaded IBD requires careful planning, preparation, and technical skills.  With a better understanding of the disease course of IBD, improved long-term impact of medical therapy and advances in endoscopic technology, we can foresee interventional IBD will become an integrated part of the multidisciplinary approach for patients with complex IBD.