Evolving roles of magnifying endoscopy and endoscopic resection for neoplasia in inflammatory bowel diseases

Abstract

Magnifying endoscopy is a useful technique to differentiate neoplasia from non-neoplastic lesions. Data regarding the clinical utility of magnifying endoscopy for neoplasia in patients with inflammatory bowel disease (IBD) has been emerging. While Kudo's pit pattern types III-V are findings suggestive of neoplasia in non-IBD patients, these pit patterns are predictive of IBD-associated neoplasia as well. However, active chronic inflammatory processes, particularly regenerative changes, can mimic neoplastic pit patterns and may affect a meticulous evaluation of pit pattern diagnosis in patients with IBD. The clinical evidence regarding the utility of magnifying endoscopy with narrow band imaging or endocytoscopy has also been evolving in regard to the diagnosis of IBD-associated neoplasia. These advanced endoscopic techniques are promising for multiple reasons; not only for making an accurate diagnosis of neoplasia, but also in determining if endoscopic resection is appropriate for such lesions in patients with IBD. In this review, we discuss the diagnostic accuracy and limitations of magnifying endoscopy in assessing IBD-associated neoplasia and examine the feasibility and outcomes of endoscopic resection for these lesions.

Keywords: Endoscopic resection; Inflammatory bowel disease; Magnifying endoscopy; Neoplasia; Ulcerative colitis.

Figure 1

Endoscopic images of a dysplastic lesion in a patient with ulcerative colitis. A: High-definition colonoscopy with white light shows a tumor recognized by a demarcated, red colored area (Paris classification Type 0-IIa, size 10 mm); B: High-definition colonoscopy with narrow band imaging (NBI); C: Magnifying chromoendoscopy with indigo carmine shows Kudo’s pit pattern types III_L and V_I low-irregularity; D: Magnifying colonoscopy with NBI shows an irregular surface pattern with increased irregular vessels (Type 2B of Japan NBI expert team classification).

Figure 2

Endoscopic images of a dysplastic lesion in a patient with ulcerative colitis. A: Magnifying chromoendoscopy with crystal violet shows Kudo’s pit pattern type V_I low-irregularity; B: Magnifying chromoendoscopy with crystal violet shows Kudo’s pit pattern type III_L; C: Endocytoscopy shows slit glandular lumens with enlarged nuclei (white arrows); D: Endoscopic submucosal dissection was conducted. Pathological report showed well to moderately differentiated adenocarcinoma.