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New Techniques in the Diagnosis of Inflammatory Bowel Disease
chromoendoscopy by performing back-to-back colonoscopy in a group of of neoplastic lesions was comparable for both endoscopic techniques. It
patients with and without chromoendoscopy.
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The Consensus Committee was considered that the low yield with NBI may have been related to
on Colorectal Cancer Surveillance in IBD has endorsed the incorporation of sampling error and the limited visualization of the first-generation prototype
chromoendoscopy for CRC surveillance in patients with UC.
55
NBI endoscopic imaging system used in the study.
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Confocal Laser Endomicroscopy Optical Coherence Tomography
Confocal laser endomicroscopy utilizes a confocal microscope attached Optical coherence tomography (OCT) provides realtime, cross-sectional,
to the distal end of the colonoscope in combination with administration high-resolution images of the colon based on the pattern of backscattering
of a topical (acriflavine) or systemic (fluorescein) contrast agent. This of infrared light and has a spatial resolution 10–25 times higher than
mucosal imaging technique allows the detection of neoplastic lesions endoscopic ultrasonography, CT, and MRI.
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OCT has been shown to be
with a sensitivity of 97% and specificity of 99%.
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A randomized trial useful in differentiating CD from UC based on the disrupted layered
evaluating the utility of chromoendoscopy in conjunction with confocal structure indicative of transmural inflammation, with a sensitivity and
laser endomicroscopy for CRC surveillance in patients with UC found a specificity of 90 and 83%, respectively.
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Although it carries the potential to
4.5-fold increase in the detection of dysplastic lesions compared with identify dysplastic lesions, further technical improvements and clinical
conventional colonoscopy.
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studies are considered necessary to support this idea in clinical practice.
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Narrow-band Imaging Conclusion
Narrow-band imaging (NBI) is a new optical technique that allows enhanced The diagnostic evaluation of IBD has evolved significantly in the past decade
visualization of mucosal structure and microvasculature with the use of with the introduction of new endoscopic and radiologic techniques. The
special optical filters and a xenon light source.
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Its main advantage over advantages of these novel technologies include, but are not limited to, earlier
chromoendoscopy and confocal laser endomicroscopy includes the detection of IBD, ability to diagnose previously unrecognized SB involvement,
preclusion of contrast dyes, and hence the ability to switch instantaneously simultaneous assessment of both mural and extramural inflammation,
from NBI to conventional mode. In a pilot study, Machida et al. showed that objective monitoring of response to therapy, performance of therapeutic
NBI was equivalent to chromoendoscopy and superior to conventional interventions, and better imaging techniques for CRC surveillance. Due to
colonoscopy in the differentiation of neoplastic from non-neoplastic lack of a gold standard, these tests have complementary roles in the
lesions.
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Dekker et al. conducted a randomized cross-over study using both diagnosis of IBD. Further studies and longer follow-up are necessary in order
NBI and conventional colonoscopy in 42 patients with UC. Despite a two- to determine the true utility and potential of these tests in the diagnosis and
fold increase in suspicious lesions detected by NBI, the overall detection rate long-term management of patients with IBD. ■
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