Hannah Gordon, Silvia Minozzi, Uri Kopylov, Bram Verstockt, Maria Chaparro, Christianne Buskens, Janindra Warusavitarne, Manasi Agrawal, Mariangela Allocca

Hannah Gordon, Livia Biancone, Gionata Fiorino, Konstantinos H Katsanos, Uri Kopylov, Eman Al Sulais, Jordan E Axelrad, Karthiha Balendran, Johan Burisch, Lissy

Main Recommendations: 1 ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist’s adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.Weak recommendation, high quality evidence. 2 ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.Strong recommendation, high quality evidence. 3 ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.Strong recommendation, moderate quality evidence. 4 ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.Weak recommendation, high quality evidence. 5 ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment. Strong recommendation, moderate quality evidence. 6 ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site. Strong recommendation, moderate quality evidence. 7 ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered. Weak recommendation, low quality evidence.

Background. IL-17 and Foxp3 double-expressing (DE) CD4+ T lymphocytes are novel crossover immune cell population, but the presence and role of these cells in h

This article is the second in a series of two publications on the European Crohn’s and Colitis Organisation [ECCO] evidence-based consensus on the management of Crohn’s disease. The first article covers medical management; the present article addresses surgical management, including preoperative aspects and drug management before surgery. It also provides technical advice for a variety of common clinical situations. Both articles together represent the evidence-based recommendations of the ECCO for Crohn’s disease and an update of prior ECCO Guidelines.

Background: The simplistically and ambiguously termed “ fibrostenosis ” of bowel is a hallmark of severe Crohn's disease (CD) and a major contributor to medical treatment failure. Noninvasive imaging assessment and novel medical therapy targeting this condition are under investigation, which particularly requires a better understanding of the underlying histologic basis. Methods: We analyzed 48 patients with stricturing Crohn’s ileitis or/and colitis that required surgical resection. The most representative sections of the fibrostenotic, non-stenotic, and uninvolved regions were reviewed for histologic analysis. For each layer of bowel wall [mucosa including muscularis mucosae (MU), submucosa (SM), muscularis propria (MP), subserosal adventitia (SS)], histologic abnormalities were evaluated individually, including active and chronic inflammation, fibrosis, smooth muscle hyperplasia or hypertrophy, neuronal hypertrophy, and adipocyte proliferation. A novel semiquantitative histological grading scheme was created. Results: The most significant histopathologic features characterizing the stricturing intestines were smooth muscle hyperplasia of SM, hypertrophy of MP, and chronic inflammation. The muscular alteration was predominant in all layers. The overall muscular hyperplasia/hypertrophy was positively correlated with chronic inflammation and negatively correlated with fibrosis, while SM muscular hyperplasia was also associated with MU active inflammation. Similar changes, to a less extent, occurred in the adjacent non-stenotic inflamed bowel as well. Conclusions: In CD-associated ‘fibrostenosis’, it is the smooth muscle hyperplasia/hypertrophy that contributes most to the stricturing phenotype, whereas fibrosis is less significant. The ‘ inflammation-smooth muscle hyperplasia axis ’ may be the most important in the pathogenesis of Crohn’s strictures.