6533b83afe1ef96bd12a799a

RESEARCH PRODUCT

Colonoscopic surveillance in inflammatory bowel disease: state of the art reduction of biopsies.

subject

description

Longstanding colitis in inflammatory bowel disease (IBD) is associated with an increased risk for intraepithelial neoplasia (IN). White light endoscopy (WLE) with 40–50 random biopsies has been promoted for surveillance but may miss a significant proportion of lesions. In addition, the yield of random biopsies to detect IN is low, and random biopsies are expensive, labor-intensive and distract from scrutinizing the colon. Chromoendoscopy with targeted biopsies has proven its superiority over WLE in multiple randomized trials. It has been incorporated into many national and international guidelines. Virtual chromoendoscopy techniques carry the potential to provide contrast enhancement without spraying color onto the mucosa. However, trials using virtual chromoendoscopy techniques have failed to show enhanced detection of IN compared to WLE so far. Autofluorescence imaging has the potential to serve as a red-flag technique for macroscopic detection of IN by screening large mucosal areas in IBD. Confocal laser endomicroscopy (CLE) is able to provide intravital microscopic diagnosis on a cellular level. In a first study, CLE had a high accuracy for prediction of neoplasia. Together, all these modern endoscopy approaches aim at overcoming shortcomings of WLE in a move towards abandoning untargeted random biopsies for targeted, ‘smart’ biopsies. Future efforts to optimize endoscopic surveillance in inflammatory colitis should aim at identifying patients at high risk of developing IN, tailor individual surveillance intervals, use red-flag techniques for IN detection and may even predict response to tailored therapy.