Advanced Endoscopic Imaging Techniques Research Articles

Early detection of ulcerative colitis-associated colorectal cancer.

Colitis-associated colorectal cancer (CACC) is one of the most serious complications of inflammatory bowel disease (IBD), particularly in ulcerative colitis (UC); it accounts for approximately 15% of all-causes mortality among IBD patients. Because CACC shows a worse prognosis and higher mortality than sporadic colorectal cancer, early detection is critical. Colonoscopy is primarily recommended for surveillance and several advanced endoscopic imaging techniques are emerging. In addition, recent studies have reported on attempts to develop clinically relevant biomarkers for surveillance using various biosamples, which may become high-performance screening tools in the future, so the best approach and technique for cancer surveillance in long-standing UC patients remain under debate. This review gives a comprehensive description and summary about what progress has been made in terms of early CACC detection.

Endoscopic analysis of colorectal serrated lesions with cancer.

Serrated lesions, including hyperplastic polyps (HPs), traditional serrated adenomas (TSAs) and sessile serrated adenomas/polyps (SSA/Ps), are important contributors to colorectal carcinogenesis. The aim of the present study was to analyze the potential of conventional endoscopy and advanced endoscopic imaging techniques to delineate the characteristic features of serrated lesions with cancer. The present study was a retrospective analysis of the data of 168 patients who had undergone colonoscopy, and a total of 228 serrated lesions (77 HPs, 58 TSAs, 84 SSA/Ps, 9 SSA/P plus TSAs) have been identified in these patients. A cancer component was identified in 2.6% of HPs, 13.8% of TSAs and 10.7% of SSA/Ps, but none of SSA/P plus TSAs. Compared with the lesions without cancer, the lesions with cancer exhibited a larger size (HP, TSA and SSA/P), a reddish appearance (SSA/P), a two-tier raised appearance (HP and SSA/P), a central depression (HP, TSA and SSA/P), the type V pit pattern (HP, TSA and SSA/P), and/or the type III capillary pattern (TSA and SSA/P). Deep invasion was identified in 50.0% of HPs, 12.5% of TSAs and 55.6% of SSA/Ps with cancer. The Ki-67 proliferative zone was distributed diffusely within the area of the cancer, but partially within the non-cancer area of HPs, TSAs and SSA/Ps. The lesion types were also analyzed on the basis of mucin phenotype. The present study suggested that a detailed endoscopic analysis of serrated lesions with cancer is useful for delineating characteristic features, and the analysis aids treatment selection.

Role of Advanced Endoscopic Imaging Techniques in the Management of Inflammatory Bowel Disease.

Endoscopy plays a crucial role in the management of inflammatory bowel disease (IBD) in terms of diagnosis, monitoring of mucosal status, and surveillance of colitis-associated neoplasia. Mucosal healing evaluated by endoscopy has been recognized as the target of treatment in the era of powerful biologics therapy. The optimal modality for identifying dysplasia in IBD has yet to be well defined. Increasing progress has recently been made in endoscopic technologies to more accurately assess mucosal inflammation and more effectively detect dysplasia. Here we review the data of advanced endoscopic imaging techniques such as chromoendoscopy, virtual chromoendoscopy, endocytoscopy, and confocal laser endomicroscopy in the management of IBD.

Advanced endoscopic imaging: European Society of Gastrointestinal Endoscopy (ESGE) Technology Review.

Background and aim: This technical review is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the utilization of advanced endoscopic imaging in gastrointestinal (GI) endoscopy. Methods: This technical review is based on a systematic literature search to evaluate the evidence supporting the use of advanced endoscopic imaging throughout the GI tract. Technologies considered include narrowed-spectrum endoscopy (narrow band imaging [NBI]; flexible spectral imaging color enhancement [FICE]; i-Scan digital contrast [I-SCAN]), autofluorescence imaging (AFI), and confocal laser endomicroscopy (CLE). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendation and the quality of evidence. Main recommendations:1. We suggest advanced endoscopic imaging technologies improve mucosal visualization and enhance fine structural and microvascular detail. Expert endoscopic diagnosis may be improved by advanced imaging, but as yet in community-based practice no technology has been shown consistently to be diagnostically superior to current practice with high definition white light. (Low quality evidence.) 2. We recommend the use of validated classification systems to support the use of optical diagnosis with advanced endoscopic imaging in the upper and lower GI tracts (strong recommendation, moderate quality evidence). 3. We suggest that training improves performance in the use of advanced endoscopic imaging techniques and that it is a prerequisite for use in clinical practice. A learning curve exists and training alone does not guarantee sustained high performances in clinical practice. (Weak recommendation, low quality evidence.) Conclusion: Advanced endoscopic imaging can improve mucosal visualization and endoscopic diagnosis; however it requires training and the use of validated classification systems.

Fuse and image enhancement.

Colorectal cancer (CRC) is the most devastating consequence of long-standing colitis in inflammatory bowel disease (IBD) patients. In a population-based study, the cumulative prevalence rates of CRC were 1%, 3%, and 7% after 10, 20, and 30 years of disease activity, respectively.1 The higher than expected rate of CRC underlies the importance of dysplasia surveillance programs in this population. However, one of the challenges faced by endoscopists is that the dysplasia seen in this cohort is mostly flat and subtle, which can be easily missed in the midst of mucosal inflammation and pseudopolyps. In addition, the use of low-definition, standard white-light colonoscopy and traditional practice of random quadrantic biopsy that only sample < 0.05% of the entire colonic mucosa lacks acceptable sensitivity and specificity in dysplasia identification and is associated with high rate of interval colitis-associated cancers.2 There is compelling evidence to support chromoendoscopy (CE) in dysplasia detection in long-standing IBD patients, and this technique has been endorsed for surveillance colonoscopy by all major guidelines including American Gastroenterological Association, American College of Gastroenterology, Crohn's and Colitis Foundation of America, European Crohn's and Colitis Organization, British Society of Gastroenterology, American Society for Gastrointestinal Endoscopy, the Australian National Health and Medical Research Council, and the Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in Inflammatory Bowel Disease Patients: International Consensus Recommendations. However, despite guideline recommendations, CE has not been widely adopted into clinical practice, mainly related to the cumbersome and time-consuming technique.3 Many endoscopists prefer to use non-dye-based digital image enhancement, such as narrow band imaging, although there is currently a lack of evidence that narrow band imaging improves the detection of dysplasia over and above CE in IBD patients.4 Recent innovations, such as confocal laser endomicroscopy and autofluorescence imaging, have been evaluated in dysplasia surveillance in IBD and appear promising in improving neoplasia detection.5-7 However, studies performed to date are small, and larger studies are clearly needed to evaluate the accuracy of these new technologies to determine their role in dysplasia screening algorithm for IBD patients. Other new imaging modalities in development are Fuji Intelligent Chromoendoscopy and i-scan that utilize surface and tone enhancement via a digital image processing algorithm, which avoids the use of contrast to better define and outline mucosal structures in real time. However, there is no study to date on the use of such technology in dysplasia surveillance in IBD patients.8 Optical coherence tomography is another new innovative imaging modality that has mainly been evaluated in Barrett's surveillance and not yet in dysplasia detection in IBD. This technology utilizes an optical probe that is balloon-centered that can be placed endoscopically to provide radial imaging scan using infrared light, capturing 1200 images over 90 s. However, given the limited performance data currently available, this technology is mainly assessed in research setting.9 Recently, a new imaging modality became available in Australia known as full spectrum endoscopy (FUSE) that maintains the capability of an adult colonoscope but has additional camera lenses to the right and left sides of the tip of the scope providing a near-panoramic 330-degree endoscopic view of the mucosa as opposed to the restricted 170-degree endoscopic view from conventional forward viewing colonoscopes. Improved visualization of the side walls, blind spots, and behind mucosal folds allows more colonic lesions to be identified, hence reducing polyp miss rates. A recent tandem back-to-back screening colonoscopy study of a non-IBD population demonstrated a significant reduction in sporadic colonic adenoma miss rates from 41% to 7% using forward viewing colonoscopes versus FUSE, respectively.10 FUSE colonoscopy has yet to be evaluated for IBD dysplasia and the benefit of FUSE in comparison against the current gold standard technique of dye-spray CE also remains unknown. In summary, improvements in the optics of endoscopes and the use of CE have improved our ability to detect dysplasia. However, the current strategies used still remains inadequate, and the development of CRC continues to fuel ongoing research in advanced endoscopic imaging techniques to improve the efficacy of dysplasia surveillance. These emerging modalities appear promising and may change our traditional approach to dysplasia screening in IBD patients in the years ahead. A major hurdle continues to be the low uptake of CE in IBD surveillance.

Advanced Endoscopic Imaging Techniques for the Study of Colonic Mucosa in Patients with Inflammatory Bowel Disease.

Crohn's disease and ulcerative colitis are inflammatory bowel diseases (IBD) associated with colorectal cancer risk in long-standing diseases. In order to assess the colonic mucosa and to discover dysplastic or neoplastic lesions, advanced endoscopic techniques are needed. Such techniques are detailed in this review: chromoendoscopy, autofluorescence imaging (AFI), narrow band imaging (NBI), i-SCAN, Fujinon Intelligent Color Enhancement (FICE) and confocal laser endomicroscopy (CLE). The aim of the review is to describe and establish the clinical impact of advanced endoscopic techniques, that could be used in IBD patients'examination in order to assess mucosal healing, microscopic inflammation, dysplasia or neoplasia. A literature research about new endoscopic approaches of patients with IBD was made. A lot of studies have been performed to reveal which imaging technique might be used for IBD surveillance. Regarding dysplasia or neoplasia detection and mucosal healing or inflammation assessment, CE proved to be superior to white light endoscopy (WLE), while NBI and AFI did not show an encouraging result. I-SCAN did not improve the colonoscopy quality while FICE has been used in a few studies. CLE could be used to characterize a lesion, providing the same results as conventional histology. At the moment, CE is the only technique which has been included in guidelines for IBD surveillance. CLE can be used to assess any lesion detected with WLE during surveillance, while the other imaging techniques require.more studies to determine their efficacy or inefficacy.

Advanced endoscopic features of ulcerative colitis-associated neoplasias: Quantification of autofluorescence imaging.

Ulcerative colitis (UC) patients are well known to carry a higher risk of developing colorectal dysplasia/cancer. However, it is hard to detect the lesion in the early phase during colonoscopy. This pilot study was conducted to analyze the endoscopic characteristics of neoplastic lesions associated with UC using advanced imaging techniques. This is a retrospective analysis of 15 colorectal neoplastic lesion obtained from 11 UC patients during remission who underwent white-light- and advanced endoscopic imaging techniques, including chromoendoscopy, narrow-band imaging and autofluorescence imaging (AFI), and were treated with surgery. These lesions were analyzed for histology, location, size, shape, color and endoscopic features. The green/red ratio was also assessed to quantify the AFI intensity. All 11 patients had extensive colitis with the median disease duration of 14.0 years. A total of 15 lesions, consisting of 8 high-grade dysplasia and 7 cancer, was mostly located in the distal colon (86.7%, 13/15) with the mean size of 8.6 mm. The shape was protruding in 46.7% (7/15), flat elevated in 40.0% (6/15) and flat in 13.3% (2/15) and the color was red in 60.0% (9/15), same colored in 33.3% (5/15) and discolored in 6.7% (1/15). The lesion predominantly showed Kudo's neoplastic pit pattern in 86.7% (13/15; 5 type IIIL, 7 type IV and 1 type VI) on chromoendoscopy and Sano's neoplastic capillary pattern (type IIIa) in 63.6% (7/11) on narrow-band imaging, but were colored purple as neoplastic lesions in only 37.5% (3/8) on AFI. Of note, the AFI green/red ratio was significantly lower in the neoplastic lesions than UC-involved areas (p=0.00014) and UC-uninvolved areas (p=0.00651) irrespective of the lesion's size and histological type. In conclusion, endoscopic analysis based on advanced imaging, in particular AFI quantitation, may be helpful to detect early stage neoplastic lesions in long standing UC. Large-scale, prospective studies are needed.

ACG Clinical Guideline: Diagnosis and Management of Barrett's Esophagus.

Barrett's esophagus (BE) is among the most common conditions encountered by the gastroenterologist. In this document, the American College of Gastroenterology updates its guidance for the best practices in caring for these patients. These guidelines continue to endorse screening of high-risk patients for BE; however, routine screening is limited to men with reflux symptoms and multiple other risk factors. Acknowledging recent data on the low risk of malignant progression in patients with nondysplastic BE, endoscopic surveillance intervals are attenuated in this population; patients with nondysplastic BE should undergo endoscopic surveillance no more frequently than every 3-5 years. Neither routine use of biomarker panels nor advanced endoscopic imaging techniques (beyond high-definition endoscopy) is recommended at this time. Endoscopic ablative therapy is recommended for patients with BE and high-grade dysplasia, as well as T1a esophageal adenocarcinoma. Based on recent level 1 evidence, endoscopic ablative therapy is also recommended for patients with BE and low-grade dysplasia, although endoscopic surveillance continues to be an acceptable alternative. Given the relatively common recurrence of BE after ablation, we suggest postablation endoscopic surveillance intervals. Although many of the recommendations provided are based on weak evidence or expert opinion, this document provides a pragmatic framework for the care of the patient with BE.

PTH-024 High correlation between kudo score and histology using chromoendoscopy

Introduction Chromoendoscopy is one of several advanced endoscopic imaging techniques that have emerged in recent years. Chromoenedoscopy can enhance and facilitate mucosal observation of pit patterns in colorectal lesions. In this study we investigated the effectiveness of this technique by exploring the correlation between Kudo score and final histology. Method This was a prospective study of all patients who had undergone endoscopic resection, by a single operator, between August 2007 and December 2012 in Bradford Royal Infirmary. Once a polyp was identified at colonoscopy, it was sprayed with Indigocarmine solution, assessed and then assigned a Kudo score (I–V). We recorded patients’ age, sex, polyp size and site, the procedure date, and the final histology. We then analysed the data by observing whether the assigned kudo score matched the final histology. A positive association was made if Kudo scores of I and II correlated with normal or hyperplastic histology, kudo scores of III and IV correlated with adenomatous histology, and if a Kudo score of V correlated with adenocarcinoma. Results In total there were 185 polypectomy cases. Of these 14 cases were excluded either because a Kudo classification was missing (7 cases), or the histology was not available (7 cases). The final analysis was performed based on the remaining 171 cases. In 149 out of these 171 cases, the Kudo score matched the final histology (87%). There was no difference in correlation score, based on polyp size or location. However, the correlation score was higher in patients under 70 age group (93%), compared to those over 70 (82%). Also, the correlation score was higher in those undergoing the procedure in 2010 or later (90%) compared to those who had it pre-2010 (82%). Conclusion Our results demonstrate a high correlation score between Kudo scoring and the final histology, using chromoendoscopy. Correlation scores improve over time with increasing exposure and practise. Characteristic pit patterns observed using chromoendoscopy helps to differentiate adenomatous from non-adenomatous polyps. In experienced hands, this technique provides a useful adjunct in the assessment of colorectal lesions, and can help make crucial decisions at the time of endoscopy. Disclosure of interest None Declared.

Differential diagnosis in inflammatory bowel disease colitis: state of the art and future perspectives.

Distinction between Crohn's disease of the colon-rectum and ulcerative colitis or inflammatory bowel disease (IBD) type unclassified can be of pivotal importance for a tailored clinical management, as each entity often involves specific therapeutic strategies and prognosis. Nonetheless, no gold standard is available and the uncertainty of diagnosis may frequently lead to misclassification or repeated examinations. Hence, we have performed a literature search to address the problem of differential diagnosis in IBD colitis, revised current and emerging diagnostic tools and refined disease classification strategies. Nowadays, the differential diagnosis is an untangled issue, and the proper diagnosis cannot be reached in up to 10% of patients presenting with IBD colitis. This topic is receiving emerging attention, as medical therapies, surgical approaches and leading prognostic outcomes require more and more disease-specific strategies in IBD patients. The optimization of standard diagnostic approaches based on clinical features, biomarkers, radiology, endoscopy and histopathology appears to provide only marginal benefits. Conversely, emerging diagnostic techniques in the field of gastrointestinal endoscopy, molecular pathology, genetics, epigenetics, metabolomics and proteomics have already shown promising results. Novel advanced endoscopic imaging techniques and biomarkers can shed new light for the differential diagnosis of IBD, better reflecting diverse disease behaviors based on specific pathogenic pathways.

The offer of advanced endoscopic imaging techniques lead to higher acceptance rates for colonoscopy – A prospective study

Background: Colonoscopy requires public and professional acceptance to ensure the ongoing success of screening programs.

State of the art in advanced endoscopic imaging for the detection and evaluation of dysplasia and early cancer of the gastrointestinal tract.

Ideally, endoscopists should be able to detect, characterize, and confirm the nature of a lesion at the bedside, minimizing uncertainties and targeting biopsies and resections only where necessary. However, under conventional white-light inspection – at present, the sole established technique available to most of humanity – premalignant conditions and early cancers can frequently escape detection. In recent years, a range of innovative techniques have entered the endoscopic arena due to their ability to enhance the contrast of diseased tissue regions beyond what is inherently possible with standard white-light endoscopy equipment. The aim of this review is to provide an overview of the state-of-the-art advanced endoscopic imaging techniques available for clinical use that are impacting the way precancerous and neoplastic lesions of the gastrointestinal tract are currently detected and characterized at endoscopy. The basic instrumentation and the physics behind each method, followed by the most influential clinical experience, are described. High-definition endoscopy, with or without optical magnification, has contributed to higher detection rates compared with white-light endoscopy alone and has now replaced ordinary equipment in daily practice. Contrast-enhancement techniques, whether dye-based or computed, have been combined with white-light endoscopy to further improve its accuracy, but histology is still required to clarify the diagnosis. Optical microscopy techniques such as confocal laser endomicroscopy and endocytoscopy enable in vivo histology during endoscopy; however, although of invaluable assistance for tissue characterization, they have not yet made transition between research and clinical use. It is still unknown which approach or combination of techniques offers the best potential. The optimal method will entail the ability to survey wide areas of tissue in concert with the ability to obtain the degree of detailed information provided by microscopic techniques. In this respect, the challenging combination of autofluorescence imaging and confocal endomicroscopy seems promising, and further research is awaited.

The evil lies below the surface: Subsquamous tumor extension in Barrett's adenocarcinoma.

The presence of intestinal metaplasia underneath the surrounding squamous epithelium is a well known phenomenon in Barrett’s esophagus (BE) 1. Mostly caused by re-epithelialization with neosquamous epithelium in the context of mucosal healing (due to acid suppressive therapy or after biopsy sampling, for example), this issue has recently attracted new attention in the context of an increasing application of ablative therapies for Barrett’s esophagus, above all radiofrequency ablation (RFA). Although follow-up studies after RFA treatment have shown that the frequency of so called “buried glands” after re-epithelialization with neosquamous epithelium is much lower than previously feared, the limited diagnostic accessibility of these structures below the surface is still worrisome due to their potential risk of malignant transformation 2 Retrospective studies on resection specimens of Barrett’s adenocarcinoma have revealed subsquamous extension of intestinal metaplasia and even neoplasia in a huge number of cases 3. Although the clinical impact of this “subsquamous tumor extension” (SSTE) is still controversial, it needs consideration in the context of assessing the lateral borders of neoplastic lesions prior to endoscopic resection, especially for carcinomas arising near the squamocolumnar junction. As for buried glands, the prediction of SSTE relying on superficial features is very difficult. Slight elevation and irregular vascular architecture might be some of the subtle changes that can be seen in areas of the squamous epithelium that have been undermined by an adjacent adenocarcinoma. Attempts to improve visualization of SSTE included the use of chromoendoscopy with acetic acid, magnifying endoscopy with narrow band imaging, and optical coherence tomography 4 5 6. However, controlled studies on the additional diagnostic yield of these techniques for the detection of SSTE are still lacking. Given that SSTE is mostly limited to a few millimeters, this raises the question whether it is really necessary to assess its precise extent in order to achieve complete resection of neoplasia. In the present study of Nagamy et al. which represents a retrospective analysis of prospectively gained clinical data, the authors investigated the efficacy of endoscopic submucosal dissection (ESD) on tumors of the esophagogastric junction (EGJ). Applying a proximal safety margin of 1 cm outside of the squamocolumnar junction or the slight elevation interpreted as SSTE, they were able to achieve an en bloc resection rate of 100 % for both gastric cardia carcinoma and Barrett’s adenocarcinoma. For the latter, the histological evaluation revealed SSTE in 12/14 cases, half of them undetected prior to endoscopic resection, but at worst 7 mm at maximum extent, wherefore the authors concluded quite rightly that a safety margin of 1 cm may be acceptable for ESD in these tumors. Although exact delineation of SSTE by advanced endoscopic imaging techniques may be fancy, the study by Nagamy et al. nicely demonstrates that a simple and clear algorithm for resection margins based on former clinical experience may lead to excellent results for endoscopic resection. Even if SSTE might be frequent and sometimes indiscernible, it seems to be a soluble problem in the endoscopic management of Barrett’s adenocarcinoma.

Confocal Laser Endomicroscopy and Molecular Imaging in Barrett Esophagus and Stomach

Detection of premalignant lesions in the upper gastrointestinal tract may facilitate endoscopic treatment and improve survival. Despite technological advances in white light endoscopy, its ability to detect premalignant lesions remains limited. Early detection could be improved by using advanced endoscopic imaging techniques, such as magnification endoscopy, narrow band imaging, i-scanning, flexible spectral imaging color enhancement, autofluorescence imaging, and confocal laser endomicroscopy (CLE), as these techniques may increase the rate of detection of mucosal abnormalities and allow optical diagnosis. The present review focuses on advanced endoscopic imaging techniques based on the use of CLE for diagnosing premalignant lesions in Barrett esophagus and stomach.

The good lies so near - invivo diagnosis of colonic polyps.

The good lies so near - invivo diagnosis of colonic polyps.

Endoscopy of Aberrant Crypt Foci: The Expert Approach

Aberrant crypt foci (ACF) were found to be possible precursors of adenoma and cancer, as well as useful surrogate lesions for chemoprevention of colorectal cancer. The aberrant crypts are stained more darkly with methylene blue and have a thicker epithelial lining and a larger pericryptal zone than normal crypts. Recently, advanced endoscopic imaging techniques have been found to be more helpful to improve detection and characterization of ACF in the colon. For inspection of ACF, optimal bowel preparation and a high-resolution endoscope equipped with a magnifying function is required. After spraying plenty of methylene blue, the mucosal surface should be washed with plenty of water to remove the sticky mucus. Once the dark blue spot is recognized with low magnification, zooming up to the maximum point should be performed. This article is part of an expert video encyclopedia.

Endoscopic Optical Enhancement Technologies in IBD

Optical enhancement technologies are emerging as promising tools to improve diagnosis and clinical management of patients with inflammatory bowel diseases (IBD). The use of dye-based and dye-less chromoendoscopy may improve either characterisation of mucosal inflammation or detection of dysplastic and early neoplastic lesions. Confocal laser endomicroscopy and endocytoscopy both allow for in vivo and real-time microscopic analysis of the tissue. Moreover, the newly introduced molecular imaging has now also become feasible for in vivo diagnosis in IBD. This review focuses on the more recent progresses of advanced endoscopic imaging techniques in the setting of IBD and provides the reader with an updated overview on accepted clinical evidence and ongoing fields of research.

Unveiling Cancer in IBD: Screening Colonoscopy or Chromoendoscopy

The risk of developing colorectal cancer (CRC) is increased in patients with inflammatory bowel disease (IBD), particularly if the disease is extensive and its duration long-standing. Endoscopic guidelines have been developed with the goal of detecting early neoplastic changes prior to development of advanced malignancy. The current surveillance strategy of surveillance colonoscopy, with multiple random biopsies, most likely reduces morbidity and mortality associated with IBD-related CRC. Unfortunately, standard surveillance colonoscopy also has limitations, including high cost and sampling error at time of biopsy. The main issue is that colitis associated neoplasms often occur in flat mucosa of normal appearance, and are detected on taking random biopsies rather than by direct identification of these lesions via endoscopic imaging. Advances in endoscopic imaging techniques, such as vital or optical chromoendoscopy, that can enhance mucosal characteristics, may potentially aid in increasing dysplasia detection rate, and may reduce the workload of standard random biopsies. The aim of this review was to describe and summarize outcomes of more advanced endoscopic imaging techniques, including chromoendoscopy and magnification endoscopy.

Advanced Endoscopic Imaging for Diagnosis of Crohn's Disease

Endoscopy in IBD has tremendous importance to diagnose inflammatory activity, to evaluate therapeutic success and for the surveillance of colitis associated cancer. Thus it becomes obvious that there is a need for new and more advanced endoscopic imaging techniques for better characterization of mucosal inflammation and early neoplasia detection in IBD. This paper describes the concept of advanced endoscopic imaging for the diagnosis and characterization of Crohn's disease, including magnification endoscopy, chromoendoscopy, balloon-assisted enteroscopy, capsule endoscopy, confocal laser endomicroscopy, and endocytoscopy.

Barrett's: Evolving Techniques for Dysplasia Detection and Endoscopic Resection

Advanced endoscopic imaging techniques have made the early diagnosis of neoplastic lesions in Barrett's esophagus easier. A new chapter in minimal invasive cancer therapy has been opened. Endoscopic treatment of early neoplasia in Barrett's esophagus (high-grade intraepithelial neoplasia and mucosal adenocarcinoma) has become the method of choice in most countries. Long-term results for endoscopic treatment in a large group of patients are now available. These emerging data suggest that endoscopic therapy is safe and highly effective with long-term complete remission rates of more than 94%. All visible lesions should be treated by endoscopic resection for histologic confirmation of the neoplastic lesion rather than by ablative techniques. After successful endoscopic resection of all visible and localizable high-grade intraepithelial neoplasia and mucosal cancer, ablative treatment of the remaining Barrett's epithelium at risk should be performed to reduce the rate of recurrent or metachronous neoplasia.