Magnifying chromoscopy, a novel and useful technique for colonoscopy in ulcerative colitis

Abstract

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by exacerbations and remissions. The degree of inflammation as assessed by conventional colonoscopy is a reliable parameter of disease activity. However, even when conventional colonoscopy suggests remission and normal mucosal findings, microscopic abnormalities may persist, and relapse may occur later. Patients with long-standing, extensive ulcerative colitis have an increased risk of developing colorectal cancer. Ulcerative colitis-associated colorectal cancer is characterized by an early age at onset, poorly differentiated tumor cells, mucinous carcinoma, and multiple lesions. Early detection of dysplasia and colitic cancer is thus a prerequisite for survival. A relatively new method, magnifying chromoscopy, is thought to be useful for the early detection and diagnosis of dysplasia and colitic cancer, as well as the prediction of relapse.

Comparison of several activity indices for the evaluation of endoscopic activity in UC: Inter- and intraobserver consistency

“…In addition, high‐resolution images are now able to distinguish minute changes to the mucosal condition. Progress in the development of endoscopic instruments, and the arrival of sophisticated technology, have made it possible to observe minute features of bowel inflammation in UC 15. Hence, high‐resolution, still endoscopic images now permit us to categorize disease activity into more than 4 levels of severity.…”

Magnifying colonoscopy used to predict disease relapse in patients with quiescent ulcerative colitis

“…Hence, target biopsies of suspicious lesions might provide more effective surveillance than taking random biopsies. [28][29][30] Hurlstone et al 31,32 reported on the efficacy of magnifying colonoscopy in UC using ''optical biopsy'' for the surveillance of colitic cancer and disease extent. Nishizawa et al 33 first reported the healing process patterns of UC mucosa using the feature of magnifying colonoscopy.…”

Dysplasia and Colitis

“…Random biopsy protocols have been documented to take longer than standard endoscopic procedures; ideally, methods to target biopsies could enhance the diagnostic yield while limiting the duration of the procedure. Both indigo carmine and methylene blue (42), combined with magnification endoscopy (43,44), have been shown in 'back-to-back' tandem endoscopies (conventional versus chromoendoscopy) to improve detection of dysplasia while limiting the number of biopsies. Narrow band imaging (NBI) (45,46) has also been evaluated in a similar manner, with lesion patterns described (47).…”