Endoscopy in Inflammatory Bowel Disease: Western Perspective—Europe

Endoscopy for IBD in Europe has in the last decade been driven by an agenda focussed on endoscopic quality and quality assurance. This has affected endoscopy in IBD practice in two specific areas; the use of chromoendoscopy for dysplasia detection, and endoscopic scoring systems of disease severity. Chromoendoscopy studies for dysplasia detection have been positive; however, it was not recommended until 2010 when the British Society of Gastroenterology (BSG) led change with a new guideline, subsequently supported by the European Crohn’s and Colitis Organisation (ECCO) and European Society for Gastrointestinal Endoscopy (ESGE), which has become the standard of care in IBD in Europe. North America still lags behind Europe in this regard. Validated scoring systems for colitis are key to ensure we speak an international “common language” between countries, but also to precisely convert research finding into clinical practice. Two validated scoring systems have become available recently, the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and the Ulcerative Colitis Colonoscopic Index of Severity (UCCIS). Regulatory agencies including the Food and Drug Administration (FDA) and European Medicines Agency (EMA) are taking an active interest in scoring systems and outcome measures in clinical trials. Quality and quality assurance are now embedded in IBD endoscopy in Europe by the use of chromoendoscopy and validated scoring systems. We need to evaluate whether this improves outcomes for patients.