Crucial Additional Value of Enteroscopy in the Diagnosis, Assessment, and Further Management of Small Bowel Crohn’s Disease

The diagnosis of Crohn’s disease is challenging as it combines clinical and laboratory clues with endoscopic, radiological and histological findings [1, 2]. Consequently, the diagnosis is often delayed or the disease is misdiagnosed, in particular in the case of mainly or exclusively ileal or jejunal involvement [3]. Enteroscopy enables deep intubation, with endoscopic visualization of the small bowel and otherwise complicated or unobtainable tissue sampling. In a secondarytertiary center, based on a strong clinical suspicion of inflammatory bowel disease (IBD) with laboratory findings consistent with Crohn’s disease, radiology could be the first step in making a diagnosis, followed directly by enteroscopy if there are clear signs of jejunal or ileal localization. This is a “top down” strategy in the diagnosis of Crohn’s disease, that might be effective in patients in whom the diagnosis is delayed.