Advanced endoscopy imaging in inflammatory bowel diseases.
OBJECTIVE
Rapid assessment of mucosal inflammation is of crucial importance for the initial diagnosis and the assessment of mucosal healing in inflammatory bowel disease (IBD). Moreover, the identification of intraepithelial neoplasias in IBD is of key relevance for clinical management. Here, we systematically analyzed the utility of advanced endoscopic imaging techniques for optimized diagnosis in IBD.


METHODS
PubMed/Medline, Web of Knowledge, and Cochrane library were searched twice for diagnostic studies on advanced endoscopic imaging in IBD. Clinical and technical information was retrieved and subsequently analyzed. Main outcome parameters consisted of the quality of the results, adverse events, and diagnostic yield.


RESULTS
Fifty-six clinical studies with a total of 3296 patients were selected for final analysis. Filter technologies permitted a more detailed analysis of mucosal inflammation in IBD. In spite of substantial heterogeneity across studies, dye-based chromoendoscopy with targeted biopsy sampling yielded higher detection rates of intraepithelial neoplasias in ulcerative colitis as compared with white-light endoscopy with random biopsy sampling. Moreover, endocytoscopy and endomicroscopy allowed subsurface imaging of inflamed or neoplastic mucosa in IBD at subcellular resolution. Finally, endomicroscopy-aided molecular imaging enabled the identification of membrane-bound tumor necrosis factor on mucosal cells as a potential driver of disease activity in Crohn's disease. No relevant adverse events were reported.


CONCLUSIONS
Advanced endoscopic imaging technologies are feasible, safe, and partially effective tools for detailed diagnosis of mucosal inflammation and detection of neoplasias in IBD. Results obtained from these advanced techniques may provide a rational basis for individualized, optimized therapy for IBD patients.
Department of Medicine II, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany.
Ralf
R
Kiesslich
Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nürnberg, Nürnberg, Germany; Ludwig Demling Endoscopy Center of Excellence, Erlangen, Germany.
Markus F
MF
Neurath
D001706:Biopsy / Q000379:methods; D002278:Carcinoma in Situ / Q000175:diagnosis / Q000473:pathology*; D004396:Coloring Agents; D016145:Endoscopy, Digestive System / Q000379:methods*; D006801:Humans; D015212:Inflammatory Bowel Diseases / Q000175:diagnosis / Q000473:pathology*; D007414:Intestinal Neoplasms / Q000175:diagnosis / Q000473:pathology*; D000069416:Intravital Microscopy / Q000379:methods; D057054:Molecular Imaging / Q000379:methods; D062048:Narrow Band Imaging
D004396:Coloring Agents