New endoscopic approaches in IBD

Abstract

Recent advances in endoscopic imaging techniques have revolutionized the diagnostic approach of patients with inflammatory bowel disease (IBD). New, emerging endoscopic imaging techniques visualized a plethora of new mucosal details even at the cellular and subcellular level. This review offers an overview about new endoscopic techniques, including chromoendoscopy, magnification endoscopy, spectroscopy, confocal laser endomicroscopy and endocytoscopy in the face of IBD.

Keywords: Chromoendoscopy; Crohn’s disease; Endocytoscopy; Endomicroscopy; Endoscopy; Fluorescence endoscopy; Fujinon intelligent color enhancement; Inflammatory bowel disease; Narrow band imaging; Spectroscopy; Ulcerative colitis; i-Scan.

Figure 1

High-resolution standard white light endoscopic image of active Crohn’s disease. Endoscopy shows ulcerations, mucosal edema and erythema.

Figure 2

Chromoendoscopy with indigo carmine. A better distinction of mucosal changes in long standing ulcerative colitis (A) and pit pattern analysis of suspicious lesions (B).

Figure 3

Virtual chromoendoscopy using the fujinon intelligent color enhancement-system. A: Shows standard white light endoscopic image; B-D: Illustrate different fujinon intelligent color enhancement settings to improve mucosal detail.

Figure 4

High-magnification endoscopy of ileum mucosa in patient with Crohn’s disease without activity. Villi are clearly visualized.

Figure 5

Confocal laser endomicroscopy using either the integrated system (iCLE, A) or the probe-based system (pCLE, B) visualizes dilated microvessels, leakage and disturbed crypt architecture in active ulcerative colitis.

Figure 6

Endocytoscopy enables visualization of different cytological and architectural features, including size, arrangement, and density of cells.