Modern Endoscopic Imaging in Diagnosis and Surveillance of Inflammatory Bowel Disease Patients

Abstract

Endoscopy remains the most important diagnostic and monitoring modality in the management of inflammatory bowel disease. Advances in imaging have progressively added new tools into the armamentarium of endoscopists with the goal of more accurate, sensitive, and accessible visual diagnoses for the benefit of patients with gastrointestinal diseases. Here, we review the relevant literature regarding commonly used endoscopic techniques (dye-based and digital chromoendoscopy, high-definition endoscopy, capsule endoscopy, and endosonography), as well as advanced and experimental technologies (full-spectrum endoscopy, endocytoscopy, autofluorescence, laser endoscopy, and endomicroscopy, including molecular imaging), applicable to inflammatory bowel diseases and emerging for implementation into everyday practice. Additionally, we discuss future directions and techniques as candidates for a superior inflammation imaging in the diagnosis and prediction of therapeutic response.

Figure 1

Endoscopic images depicting Crohn's disease (CD) and ulcerative colitis (UC) lesions with different techniques and resolutions: image (a) shows a moderate to severe Crohn's colitis, while (b) shows a mild UC (endoscopic Mayo 1), both in standard definition. Images (c) and (d) depict again a distal UC involvement in high-definition white light (HD-WLE) as well as in digital chromoendoscopy using i-Scan (Mayo 1–2). In comparison, pictures (e) and (f) show a severe CD of the ileum and colon (high-definition WLE and i-Scan). Images (g) and (h) show high-definition WLE and narrow-band imaging (NBI) (h) of a gastric CD, highlighting erosions and aphthoid lesions.

Figure 2

Endomicroscopic imaging in Crohn's disease and ulcerative colitis. Images (a) and (b) show endomicroscopic images provided by the integrated system (eCLE) with typical inflamed crypts and hypervascularization in Crohn's colitis (a) and ulcerative colitis (b); arrowhead points towards vascular leakage. Pictograms (c) and (d) show endomicroscopic images provided by the probe-based system (pCLE) in a Crohn's disease patient with colonic and ileal involvement (arrowhead in (c) shows a deformed crypt with lumen leakage; arrowhead in (d) shows a typical epithelial gap). (e) shows a premier molecular endomicroscopic imaging of golimumab FITC (ex vivo eCLE) in an ulcerative colitis patient that underwent proctocolectomy (arrowhead shows golimumab FITC-positive cells in the lamina propria, suggesting the high number and density of effector cells of inflammation).