Magnification endoscopy, chromoendoscopy and other novel techniques in evaluation of patients with IBD

Abstract

Magnification endoscopy and chromoendoscopy are two new endoscopic techniques which have been introduced into clinical practice over the past decade with uses in patients both with and without inflammatory bowel disease. Specific uses for these techniques in patients without inflammatory bowel disease include evaluating for celiac sprue and tropical sprue, detection of squamous cell esophageal cancer, detection of Barrett’s esophagus and its associated neoplasia, as well as assisting in the detection of colorectal neoplasia for which specific pit pattern appearances have been described. In patients with ulcerative colitis, magnification endoscopy and chromoendoscopy have been shown to significantly increase the overall detection of colorectal neoplasia, particularly in flat colorectal lesions, as compared with conventional endoscopy. In addition, pit pattern analysis has allowed these techniques to be highly accurate in predicting neoplasia at histology. Thus, with magnification endoscopy and chromoendoscopy, targeted biopsy during colorectal neoplasia surveillance in ulcerative colitis may become feasible in the not too distant future. Finally, magnification endoscopy and chromoendoscopy have been shown to be significantly more accurate than conventional endoscopy in predicting the extent of ulcerative colitis and in predicting mild histologic disease. These techniques do not appear to be helpful in predicting severe histologic disease, and it is unclear at this time if they will be useful for predicting moderate histologic disease. Specific trials using magnification endoscopy and chromoendoscopy to predict response to therapy have not yet been done to determine whether these findings will translate into any significant clinical advantage.