**2. Indications of SB endoscopy in IBD**

*Endoscopy in Small Bowel Diseases*

device assisted enteroscopy (DAE) (which includes single balloon enteroscopy-SBE, double balloon enteroscopy - DBE, spiral enteroscopy, novel motorised spiral enteroscopy - NMSE and balloon guided endoscopy) (**Figure 1C**) and intra-opera-

*Types of small bowel endoscopy. A. Video capsule endoscopy for small bowel (PillCam, given imaging ltd., Yokñeam Illit, Isareal), B. retained capsule removed at laparotomy, C. single balloon enteroscope (SIF-Q180, Olympus, Tokyo, Japan) with overture and balloon, D. intra-operative enteroscopy being performed at* 

[3]. Among them, 90% have involvement of terminal ileum. Skip lesions in terminal ileum can lead to false negative results. So for diagnosis of suspected CD, ileo-colonoscopy is the first line investigation [4]. VCE is the preferred initial diagnostic modality in cases with suspected CD and negative ileo-colonoscopy in the absence of obstructive symptoms or known stenosis. However, small bowel evaluation is warranted in all newly diagnosed cases of CD as small bowel is involved in every 2 out of 3 CD patients and the involvement can be discontinuous. In this scenario, cross sectional imaging (CTE/MRE) is preferred over VCE due to its potential to assess transmural and extra-luminal disease. VCE is indicated subsequently if cross sectional imaging is non-contributory. Patients with suspected small bowel involvement on cross sectional imaging or VCE, DAE with small bowel biopsy can provide definitive evidence of CD. Additionally, DAE is recommended for treatment of small bowel strictures amenable for endoscopic therapy, small bowel bleeding and retrieval of foreign bodies/retained capsule. For assessing the response to therapy in small bowel CD, VCE can be considered in primarily nonstricturing CD [2]. Hence, small bowel endoscopy has major implications in the diagnosis and classification, therapeutic decision making and altering treatment

In about two-thirds of patients with CD, small bowel is involved at diagnosis

tive enteroscopy (IOE) (**Figure 1D**) [2].

**48**

**Figure 1.**

*laparotomy.*

outcomes in IBD [5].

The Indications of small bowel endoscopy in IBD are [2, 5]

