Endoscopic Surveillance in Inflammatory Bowel Diseases: Selecting a Suitable Technology

Abstract

In the treat-to-target era, endoscopy has become the backbone of the assessment of remission, defined as mucosal healing, in inflammatory bowel disease (IBD) patients. Current recommendations indicate that endoscopic procedures should be performed with high-definition white-light endoscopy (HD-WLE), as it guarantees the best possible visualization of the mucosa. With respect to endoscopic surveillance, the preventive strategy for dysplasia and colorectal cancer (CRC) in long-standing IBD, is the use of dye-chromoendoscopy (DCE), which enhances the mucosal pattern of the colonic walls. DCE has been established as the gold standard for dysplasia detection and is at present incorporated in all international guidelines. Over the past years, novel technologies, such as high-definition endoscopic imaging, and optical and digital enhancement tools have revolutionized the quality and level of fine details of vascular and mucosal patterns. These endoscopic images have the ambition to reflect histological changes for suspected neoplastic lesions and inflammation or healing and are emerging as potential alternatives to DCE. Indeed, the comparison of DCE with high-definition imaging is an open issue that deserves further investigation. We aimed to examine and summarize the technical aspects and the current evidence on endoscopic technologies with a specific focus on the surveillance in IBD patients.

Next-Generation Endoscopy in Inflammatory Bowel Disease

“…As a result, the contrast between abnormal lesions and the surrounding normal colorectal mucosa is heightened, allowing for more accurate detection and characterization of the mucosal surface and borders of colonic lesions. It enhances the ability to predict histology accurately and guide appropriate therapy [13].…”

Vigilancia endoscópica en pacientes con enfermedad inflamatoria intestinal: guías y recomendaciones

“…Estas son el estándar de cuidado en los pacientes con EII para mejorar la visualización y la caracterización de la mucosa: cromoendoscopia con tinción (DCE, dye-spray), WLE, NBI, M-NBI, CV, iScan, HD-CE, AFI y FUSE 6 .…”

“…Con esta técnica, en 12 estudios, se reporta una probabilidad de detección de lesiones (OR: 2.385; IC95%: 1.687-3.37) menor que con la endoscopia de alta definición. La comparación de la luz blanca muestra menor detección de lesiones en comparación con la cromoendoscopia con tinción, de acuerdo con reportes de estudios aleatorizados con luz blanca estándar (4 estudios retrospectivos; OR: 1.917) en comparación con cromoendoscopia con tinción (4 estudios prospectivos; OR: 7.428) 6 .…”

“…La detección en 12 estudios con HD-WLE reporta una OR de 2.385 (IC95%: 1.687-3), y cuando se compara con DCE es mayor la detección, con una OR de 4.218 (IC95%: 1.240-14.345), por lo que HD-WLE detecta menos lesiones que la DCE. La comparación entre técnicas ópticas, como DCE, FUSE y AFI, muestra que la luz blanca detecta menos lesiones que la cromoendoscopia digital (OR: 2.605), la FUSE (OR: 7.367) y la AFI (OR: 3.055) 6 .…”

Artificial Intelligence in Inflammatory Bowel Disease Endoscopy: Advanced Development and New Horizons

“…Over the past few years, the importance of endoscopy in the diagnosis, treatment, and monitoring of IBD has been established. For example, dye-chromo endoscopy (DCE) and virtual chromo endoscopy (VCE) are often used in the endoscopic surveillance of IBD [ 6 ]. In DCE, topical dye is sprayed on the colon wall, enhancing the visualization of mucosal morphology.…”