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Advances in the Endoscopic Assessment of Inflammatory Bowel Diseases: Cooperation between Endoscopic and Pathologic Evaluations.

Cheon JH - J Pathol Transl Med (2015)

Bottom Line: Dye-less chromoendoscopy, including narrow band imaging, iScan, and autofluorescence imaging can also enhance surveillance in comparison to white light endoscopy with optical or electronic filter technologies.Moreover, confocal laser endomicroscopy or endocytoscopy have can achieve real-time histology evaluation in vivo and have greater accuracy in comparison with histology.These new technologies could be combined with standard endoscopy or further histologic confirmation in patients with IBD.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Endoscopic assessment has a crucial role in the management of inflammatory bowel disease (IBD). It is particularly useful for the assessment of IBD disease extension, severity, and neoplasia surveillance. Recent advances in endoscopic imaging techniques have been revolutionized over the past decades, progressing from conventional white light endoscopy to novel endoscopic techniques using molecular probes or electronic filter technologies. These new technologies allow for visualization of the mucosa in detail and monitor for inflammation/dysplasia at the cellular or sub-cellular level. These techniques may enable us to alter the IBD surveillance paradigm from four quadrant random biopsy to targeted biopsy and diagnosis. High definition endoscopy and dye-based chromoendoscopy can improve the detection rate of dysplasia and evaluate inflammatory changes with better visualization. Dye-less chromoendoscopy, including narrow band imaging, iScan, and autofluorescence imaging can also enhance surveillance in comparison to white light endoscopy with optical or electronic filter technologies. Moreover, confocal laser endomicroscopy or endocytoscopy have can achieve real-time histology evaluation in vivo and have greater accuracy in comparison with histology. These new technologies could be combined with standard endoscopy or further histologic confirmation in patients with IBD. This review offers an evidence-based overview of new endoscopic techniques in patients with IBD.

No MeSH data available.


Related in: MedlinePlus

Confocal laser endomicroscopic findings for normal mucosa (A) and mucosa in active ulcerative colitis (B). In ulcerative colitis, lamina propria widening, inflammatory infiltrates, goblet cell depletion, and crypt distortion are observed.
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f3-jptm-49-3-209: Confocal laser endomicroscopic findings for normal mucosa (A) and mucosa in active ulcerative colitis (B). In ulcerative colitis, lamina propria widening, inflammatory infiltrates, goblet cell depletion, and crypt distortion are observed.

Mentions: Observation and characterization of the colonic mucosal surface and abnormalities of blood vessel architecture are crucial in predicting histology, and this can be performed more efficiently with chromoendoscopy. However, histologic confirmation is needed to determine whether the presence of mucosal abnormalities is a result of IBD or not. This can be accomplished by confocal endomicroscopy in vivo, which may provide images similar to histologic findings in real time (Fig. 3). Endomicroscopy is regarded as optical biopsy that can achieve an image of the cellular structure of the mucosa with 1,500 fold magnification [38]. Currently, two endomicroscopy systems are available including an integrated endoscopy system (iCLE, Pentax) and a probe-based system (pCLE, Cellvizio, Mauna Kea Technologies, Paris, France). In vivo CLE uses an excitation wavelength of 488 nm with a single line laser; the laser power output is up to 1 mW at the tissue surface. Images are collected at a scan rate of 0.8 frames per second at a resolution of 1,024×1,024 pixels or 1.6 frames per second with 1,024×512 pixels [39]. It can capture the z axis which enables interrogation of the epithelium and lamina propria 0–250 mm below the surface layer [40]. The pCLEsystem uses a fixed laser power and a fixed image plane depth. The purpose of the system is to observe mucosal microarchitecture with an increased field of view (4×2 mm) through postpocessing with Cellvio Viewer (Fig. 4A). It enables virtual staining of mucosal structures to further enhance tissue contrast. The probe requires an accessory channel of 2.8 mm and has a resolution of 1 μm with a field of view of 240 μm and a fixed image plane depth varying between 55–65 μm (Fig. 4B).


Advances in the Endoscopic Assessment of Inflammatory Bowel Diseases: Cooperation between Endoscopic and Pathologic Evaluations.

Cheon JH - J Pathol Transl Med (2015)

Confocal laser endomicroscopic findings for normal mucosa (A) and mucosa in active ulcerative colitis (B). In ulcerative colitis, lamina propria widening, inflammatory infiltrates, goblet cell depletion, and crypt distortion are observed.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4440932&req=5

f3-jptm-49-3-209: Confocal laser endomicroscopic findings for normal mucosa (A) and mucosa in active ulcerative colitis (B). In ulcerative colitis, lamina propria widening, inflammatory infiltrates, goblet cell depletion, and crypt distortion are observed.
Mentions: Observation and characterization of the colonic mucosal surface and abnormalities of blood vessel architecture are crucial in predicting histology, and this can be performed more efficiently with chromoendoscopy. However, histologic confirmation is needed to determine whether the presence of mucosal abnormalities is a result of IBD or not. This can be accomplished by confocal endomicroscopy in vivo, which may provide images similar to histologic findings in real time (Fig. 3). Endomicroscopy is regarded as optical biopsy that can achieve an image of the cellular structure of the mucosa with 1,500 fold magnification [38]. Currently, two endomicroscopy systems are available including an integrated endoscopy system (iCLE, Pentax) and a probe-based system (pCLE, Cellvizio, Mauna Kea Technologies, Paris, France). In vivo CLE uses an excitation wavelength of 488 nm with a single line laser; the laser power output is up to 1 mW at the tissue surface. Images are collected at a scan rate of 0.8 frames per second at a resolution of 1,024×1,024 pixels or 1.6 frames per second with 1,024×512 pixels [39]. It can capture the z axis which enables interrogation of the epithelium and lamina propria 0–250 mm below the surface layer [40]. The pCLEsystem uses a fixed laser power and a fixed image plane depth. The purpose of the system is to observe mucosal microarchitecture with an increased field of view (4×2 mm) through postpocessing with Cellvio Viewer (Fig. 4A). It enables virtual staining of mucosal structures to further enhance tissue contrast. The probe requires an accessory channel of 2.8 mm and has a resolution of 1 μm with a field of view of 240 μm and a fixed image plane depth varying between 55–65 μm (Fig. 4B).

Bottom Line: Dye-less chromoendoscopy, including narrow band imaging, iScan, and autofluorescence imaging can also enhance surveillance in comparison to white light endoscopy with optical or electronic filter technologies.Moreover, confocal laser endomicroscopy or endocytoscopy have can achieve real-time histology evaluation in vivo and have greater accuracy in comparison with histology.These new technologies could be combined with standard endoscopy or further histologic confirmation in patients with IBD.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT
Endoscopic assessment has a crucial role in the management of inflammatory bowel disease (IBD). It is particularly useful for the assessment of IBD disease extension, severity, and neoplasia surveillance. Recent advances in endoscopic imaging techniques have been revolutionized over the past decades, progressing from conventional white light endoscopy to novel endoscopic techniques using molecular probes or electronic filter technologies. These new technologies allow for visualization of the mucosa in detail and monitor for inflammation/dysplasia at the cellular or sub-cellular level. These techniques may enable us to alter the IBD surveillance paradigm from four quadrant random biopsy to targeted biopsy and diagnosis. High definition endoscopy and dye-based chromoendoscopy can improve the detection rate of dysplasia and evaluate inflammatory changes with better visualization. Dye-less chromoendoscopy, including narrow band imaging, iScan, and autofluorescence imaging can also enhance surveillance in comparison to white light endoscopy with optical or electronic filter technologies. Moreover, confocal laser endomicroscopy or endocytoscopy have can achieve real-time histology evaluation in vivo and have greater accuracy in comparison with histology. These new technologies could be combined with standard endoscopy or further histologic confirmation in patients with IBD. This review offers an evidence-based overview of new endoscopic techniques in patients with IBD.

No MeSH data available.


Related in: MedlinePlus