Endomicroscopy is a new imaging tool for gastrointestinal endoscopy. In vivo histology becomes possible at subcellular resolution during ongoing colonoscopy. Panchromoendoscopy with targeted biopsies has become the method of choice for surveillance of patients with inflammatory bowel disease. Endomicroscopy can be added after chromoendoscopy to clarify whether standard biopsies are needed. This smart biopsy concept can increase the diagnostic yield of intraepithelial neoplasia and substantially reduce the need for biopsies. Clinical acceptance is increasing because of a multitude of positive studies about the diagnostic value of endomicroscopy. Smart biopsies, functional imaging, and molecular imaging may represent the future for endomicroscopy.
Key points
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Endomicroscopy is a new imaging tool for gastrointestinal endoscopy.
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Panchromoendoscopy with targeted biopsies has become the method of choice for surveillance of patients with inflammatory bowel disease.
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Endomicroscopy can be added after chromoendoscopy to clarify whether standard biopsies are still needed.
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This smart biopsy concept can increase the diagnostic yield of intraepithelial neoplasia and substantially reduce the need for biopsies.
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Endomicroscopy is still mainly used for research but clinical acceptance is increasing because of a multitude of positive studies about the diagnostic value of endomicroscopy.
Introduction
Patients with long-standing extensive chronic inflammatory bowel disease (IBD) have an increased risk to develop intraepithelial neoplasia and colitis-associated cancer compared with the average population risk. Triggers to neoplasia are chronic inflammation and sporadic adenoma. Thus, colonoscopic surveillance is recommended in patients with long-lasting ulcerative colitis (left side and pancolitis) as well as Crohn’s colitis. Guidelines recommend performing targeted (visible lesions) and random biopsies. Here, 2 to 4 random biopsies every 10 cm within the colon should be performed. Dysplastic lesions are often multifocal, flat, and difficult to detect with white light endoscopy.
In 2003, the first randomized controlled trial was published evaluating lesions in the colon according to a modified pit pattern classification after panchromoendoscopy with methylene blue (0.1%) (pit pattern I–II, endoscopic prediction of nonneoplastic lesions; pit pattern III–V, endoscopic prediction of neoplastic lesions). Chromoendoscopy made it possible to identify dysplastic lesions and to clarify the borders between neoplastic and normal tissue. This development has led to the smart biopsy concept, in which more targeted biopsies become possible after enhanced endoscopy (chromoendoscopy) ( Figs. 1–3 ). Panchromoendoscopy has become the method of choice for endoscopic surveillance of patients with IBD (European consensus guidelines).
Confocal laser endomicroscopy (CLE) is a research and clinical tool that promises to improve diagnostics and therapeutic algorithms in patients with IBD. Endomicroscopy has been shown to be useful in dysplasia detection and differentiation of lesions to optimize their management (differentiation between colitis-associated neoplasia, sporadic neoplasia, and nonneoplastic lesions) and to reduce the number of unnecessary biopsies. Confocal endomicroscopy has for the first time revealed in vivo tissue microscopy to gastroenterologists. Using this technology, changes in vessel, connective tissue, and cellular-subcellular structures can be graduated during ongoing colonoscopy at subcellular resolution.
Confocal endomicroscopy has been shown to decrease the need for random biopsies because it has a high negative predictive value. Its use is often combined with chromoendoscopy. Intravital staining is used to identify lesions and targeted endomicroscopy is performed to clarify the need for standard biopsies. Thus, endomicroscopically normal-looking mucosa does not usually require further standard biopsies. Neoplastic changes and regenerative tissue can readily be identified using this method. However, detailed knowledge about the microarchitecture of the mucosa is necessary to achieve high diagnostic yields.
Introduction
Patients with long-standing extensive chronic inflammatory bowel disease (IBD) have an increased risk to develop intraepithelial neoplasia and colitis-associated cancer compared with the average population risk. Triggers to neoplasia are chronic inflammation and sporadic adenoma. Thus, colonoscopic surveillance is recommended in patients with long-lasting ulcerative colitis (left side and pancolitis) as well as Crohn’s colitis. Guidelines recommend performing targeted (visible lesions) and random biopsies. Here, 2 to 4 random biopsies every 10 cm within the colon should be performed. Dysplastic lesions are often multifocal, flat, and difficult to detect with white light endoscopy.
In 2003, the first randomized controlled trial was published evaluating lesions in the colon according to a modified pit pattern classification after panchromoendoscopy with methylene blue (0.1%) (pit pattern I–II, endoscopic prediction of nonneoplastic lesions; pit pattern III–V, endoscopic prediction of neoplastic lesions). Chromoendoscopy made it possible to identify dysplastic lesions and to clarify the borders between neoplastic and normal tissue. This development has led to the smart biopsy concept, in which more targeted biopsies become possible after enhanced endoscopy (chromoendoscopy) ( Figs. 1–3 ). Panchromoendoscopy has become the method of choice for endoscopic surveillance of patients with IBD (European consensus guidelines).
Related posts:
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Mucosal Healing As a Target of Therapy for Colonic Inflammatory Bowel Disease and Methods to Score Disease Activity
Quality Bowel Preparation for Surveillance Colonoscopy in Patients with Inflammatory Bowel Disease Is a Must
The Unique Pathology of Nonpolypoid Colorectal Neoplasia in IBD
Toward a Consensus on Endoscopic Surveillance of Patients with Colonic Inflammatory Bowel Disease
Surgical Management of Nonpolypoid Colorectal Lesions and Strictures in Colonic Inflammatory Bowel Disease
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