Inflammatory bowel disease offers a unique opportunity to explore the potential of molecular imaging for both detection and to guide therapy. Because of the increasing array of monoclonal antibody treatments for inflammatory bowel disease, there is significant potential for molecular imaging using fluorescent-labeled monoclonal antibodies to determine binding density and potentially to predict response to therapy [16]. In a proof of concept of this, Atrya et al. used topically applied fluorescent-labeled adalimumab followed by confocal imaging to assess adalimumab binding. They were able to show that patients with a strong binding of labeled adalimumab had significantly better short-term response to adalimumab therapy [17]. Molecular imaging has been evaluated for cancer and dysplasia detection. For example, molecular imaging probes that are activated by proteases such as cathepsin were found to be significantly upregulated when imaged by CLE in ulcerative colitis patients with dysplasia compared to those without dysplasia [18]. Raman spectroscopy, which evaluates subcellular biochemical changes in the tissue, has also been shown to be promising in detection of inflammatory bowel disease [19].

Other potential future applications include direct drug delivery, which would be most applicable in focal areas of inflammatory bowel disease such as Crohn’s disease associated strictures with isolated areas of inflammation.