Post written by Markus F. Neurath, MD, from the Medical Clinic 1, Department of Medicine, University Hospital Erlangen, University of Erlangen-Nuremberg, Erlangen, Germany.

The introduction of mucosal healing as a key therapeutic goal in IBD patients has highlighted the importance of endoscopy for therapeutic monitoring. Additionally, endoscopy plays a crucial role in cancer surveillance in IBD. Thus, the focus of this article was to summarize the knowledge on the role of endosopic imaging in IBD. While many studies on endoscopy have been published in recent years, a systematic review on this topic was lacking. We, therefore, decided to prepare a systematic review on this topic.

Figure 2. Techniques used in IBD endoscopy and their potential applications. WLE plays a major role for characterization of the macroscopically visible disease activity, the analysis of mucosal healing, and localization of affected areas in the GI tract. High-definition endoscopy with filter techniques and CE are useful for determining the precise extent of inflammation and the prediction of neoplasias. Moreover, endocytoscopy and endomicroscopy may be used for descriptive imaging of cells and tissues, functional barrier analysis, and molecular imaging.

This systematic review covered 56 clinical studies with a total of 3296 patients. Results showed that filter technologies permited a more detailed analysis of mucosal inflammation in IBD. Additionally, dye-based chromoendoscopy with targeted biopsies yielded higher detection rates of intraepithelial neoplasias in ulcerative colitis as compared to white-light endoscopy with random biopsies. Moreover, endocytoscopy and endomicroscopy allowed subsurface imaging of inflamed or neoplastic mucosa in IBD at subcellular resolution. Finally, endomicroscopy-aided molecular imaging enabled the identification of membrane-bound TNF on mucosal cells as a potential driver of disease activity in Crohn´s disease. Collectively, the results demonstrate that advanced endoscopic imaging technologies are feasible, safe, and partially effective tools for detailed diagnosis of mucosal inflammation and detection of neoplasias in IBD. Results obtained from these advanced techniques may provide a rational basis for individualized, optimized therapy for IBD patients.

Find the article abstract here.

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