Role of new endoscopic techniques in inflammatory bowel disease management: Has the change come?

Abstract

Despite significant therapeutic progress in recent years, inflammatory bowel disease (IBD), which includes Crohn’s disease and ulcerative colitis, remains a challenge regarding its pathogenesis and long-term complications. New concepts have emerged in the management of this disease, such as the “treat-to-target” concept, in which mucosal healing plays a key role in the evolution of IBD, the risk of recurrence and the need for surgery. Endoscopy is essential for the assessment of mucosal inflammation and plays a pivotal role in the analysis of mucosal healing in patients with IBD. Endoscopy is also essential in the detection of dysplasia and in the identification of the risk of colon cancer. The current surveillance strategy for dysplasia in IBD patients indicates white-light endoscopy with non-targeted biopsies. The new chromoendoscopy techniques provide substantial benefits for both clinicians and patients. Narrow-band imaging (NBI) has similar rates of dysplastic lesion detection as white-light endoscopy, and it seems that NBI identifies more adenoma-like lesions. Because it is used instinctively by many endoscopists, the combination of these two techniques might improve the rate of dysplasia detection. Flexible spectral imaging color enhancement can help differentiate dysplastic and non-dysplastic lesions and can also predict the risk of recurrence, which allows us to modulate the treatment to gain better control of the disease. The combination of non-invasive serum and stool biomarkers with endoscopy will improve the monitoring and limit the evolution of IBD because it enables the use of a personalized approach to each patient based on that patient’s history and risk factors.

Keywords: Chromoendoscopy; Flexible spectral imaging color enhancement; Inflammatory bowel disease; Dysplasia; Mucosal healing; Narrow band imaging

Core tip: New concepts have emerged in the management of inflammatory bowel disease, such as the “treat-to-target” concept in which mucosal healing plays a key role in the evolution, risk of recurrence and need for surgery. Endoscopy is essential for the assessment of mucosal inflammation and plays a pivotal role in the analysis of mucosal healing in patients with inflammatory bowel disease (IBD) and in the detection of dysplasia and assessment of the risk of colon cancer. The current surveillance strategy for dysplasia in IBD patients indicates white-light endoscopy with non-targeted biopsies. Despite the screening program, the high rate of colorectal cancer among IBD patients illustrates the need for better and more efficient techniques for dysplasia recognition. Classical chromoendoscopy and new digital techniques have provided promising results. In addition to the endoscopy techniques, stool and blood biomarkers are beneficial for the assessment of disease progress and disease monitoring. When used wisely and combined with the endoscopic methods, these techniques are promising in terms of the selection of patients for the early detection of dysplastic lesions and the prevention of inflammatory relapse.