Present and future of endoscopy precision for inflammatory bowel disease

Abstract

Several advanced imaging techniques are now available for endoscopists managing inflammatory bowel disease (IBD) patients. These tools, including dye-based and virtual chromoendoscopy, probe-based confocal laser endomicroscopy and endocytoscopy, are increasingly innovative applications in clinical practice. They allow for a more in-depth and refined evaluation of the mucosal and vascular bowel surface, getting closer to histology. They have demonstrated a remarkable ability in assessing intestinal inflammation, histologic remission, and predicting relapse and favorable long-term outcomes. In addition, the future application of molecular endoscopy to predict biological drug responses has yielded preliminary but encouraging results. Furthermore, these techniques are crucial in detecting and characterizing IBD-related dysplasia, assisting endoscopic mucosal resection and submucosal dissection towards a surgery-sparing approach. Artificial intelligence (AI) holds great potential in this promising landscape, as it can provide an objective and reproducible assessment of inflammation and dysplasia. Moreover, it can improve the prediction of outcomes and aid in subsequent therapeutic decision-making. This review aims to summarize the promising role of state-of-the-art advanced endoscopic techniques and related AI-enabled models for managing IBD, paving the way for precision medicine.

Keywords: artificial intelligence; chromoendoscopy; confocal laser endomicroscopy; endocytoscopy; precision medicine.

Figure 1

Paddington International Virtual Chromoendoscopy (PICaSSO) score. This figure schematically represents the novel score based on virtual chromoendoscopy called PICaSSO. The PICaSSO score grades architectural changes of the mucosa (including microerosions, cryptal abscess, and ulcers) and of vessels (such as dilatated or crowded vessels and bleeding). It ranges from 0 to 15 and endoscopic remission is defined by a score equal to or <3. Created with Biorender.com.

Figure 2

Advanced endoscopy for detection and assessment of inflammatory bowel disease (IBD)‐related colonic lesions. This figure highlights the role of advanced endoscopy in the detection and assessment of IBD‐related colonic lesions. Images provided were obtained through dye‐based chromoendoscopy (DCE), virtual electronic chromoendoscopy (VCE), confocal laser endomicroscopy, and endocytoscopy. pCLE, probe‐based confocal laser endomicroscopy. Created with Biorender.com.