Applying small bowel endoscopy in inflammatory bowel disease management

Inflammatory bowel disease is classified into Crohn's disease (CD) and ulcerative colitis. Ulcerative colitis involves only the colon, whereas CD is characterized by small bowel involvement, which is a hallmark feature. However, the small bowel is the final frontier of endoscopic evaluation; therefore, small bowel involvement is considered a significant medical challenge in the diagnosis and treatment of patients with CD. Endoscopic visualization and biopsy sampling of the small bowel are crucial for accurate diagnosis, effective monitoring, and management of complications of CD. Small bowel endoscopy enables the early detection of mucosal lesions, facilitates timely intervention for complications such as strictures or bleeding, and plays a critical role in reducing the need for surgical resection. Moreover, it enables targeted tissue acquisition and objective assessment of disease activity, both of which are crucial for optimal treatment planning and monitoring of therapeutic responses. Given these clinical advantages, small bowel endoscopy has become an indispensable tool in the comprehensive management of CD. This review summarizes the current role and evolving advances in small bowel endoscopy, with particular emphasis on its therapeutic applications-including enteroscopic balloon dilation, endoscopic hemostasis, and foreign body retrieval-and discusses future directions based on recent evidence and expert guidelines.