Next-Generation Endoscopy in Inflammatory Bowel Disease

Abstract

Endoscopic healing is recognized as a primary treatment goal in Inflammatory Bowel Disease (IBD). However, endoscopic remission may not reflect histological remission, which is crucial to achieving favorable long-term outcomes. The development of new advanced techniques has revolutionized the field of IBD assessment and management. These tools can accurately assess vascular and mucosal features, drawing endoscopy closer to histology. Moreover, they can enhance the detection and characterization of IBD-related dysplasia. Given the persistent challenge of interobserver variability, a more standardized approach to endoscopy is warranted, and the integration of artificial intelligence (AI) holds promise for addressing this limitation. Additionally, although molecular endoscopy is still in its infancy, it is a promising tool to forecast response to therapy. This review provides an overview of advanced endoscopic techniques, including dye-based and dye-less chromoendoscopy, and in vivo histological examinations with probe-based confocal laser endomicroscopy and endocytoscopy. The remarkable contribution of these tools to IBD management, especially when integrated with AI, is discussed. Specific attention is given to their role in improving disease assessment, detection, and characterization of IBD-associated lesions, and predicting disease-related outcomes.

Keywords: artificial intelligence; chromoendoscopy; confocal laser endomicroscopy; dysplasia; endocytoscopy; inflammation; molecular endoscopy.

Figure 1

Inflammatory Bowel Disease (IBD)-related colonic lesion detection and characterization. In this figure is highlighted the pivotal role of advanced endoscopic techniques in the detection and characterization of colonic lesions associated with IBD. Images obtained through dye-based chromoendoscopy, virtual electronic chromoendoscopy, probe-based confocal laser endomicroscopy, and endocytoscopy are presented. Created with ‘Biorender.com’. Abbreviations: DCE, dye-based chromoendoscopy; IBD, inflammatory bowel disease; pCLE, probe-based confocal laser endomicroscopy; VCE, virtual electronic chromoendoscopy.

Figure 2

The future of endoscopic precision in Inflammatory Bowel Disease (IBD). This figure shows the emerging endoscopic techniques for the assessment of patients with IBD. Images captured through probe-based confocal laser endomicroscopy, endocytoscopy, and molecular endoscopy are presented. Also, the figure highlights the potential of artificial intelligence in enhancing and optimizing these techniques. The lower section of the figure provides a summary of the improvements associated with these advanced tools, highlighting their role in personalizing therapy and enabling real-time decision-making during endoscopic procedures. Created with ‘Biorender.com’. Abbreviations: AI, artificial intelligence; IBD, inflammatory bowel disease; pCLE, probe-based confocal laser endomicroscopy.