Evolving endoscopic technologies for the detection of dysplasia in inflammatory bowel diseases

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Andrea Buda, Francesca Lamboglia, Giorgia Hatem, Renata D’Incà, Giacomo Carlo Sturniolo

Ann. Ital. Chir., 2011 82: 29-35

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Patients with long-standing and extensive ulcerative colitis (UC) and colonic Chron’s disease (CD) have an increased
risk of CRC compared with the general population. Although no large controlled trials have proven that surveillance
reduces mortality, cancer prevention in inflammatory bowel disease depends on the detection of dysplasia during scheduled
surveillance colonoscopy and is widely recommended by gastroenterological associations. Dysplasia in IBD may occur
in flat mucosa or in raised lesions (DALM) which have sometimes endoscopic features similar to adenoma (adenomalike
DALM). Recently, new endoscopic techniques to facilitate the distinction between dysplastic and actively inflamed
or normal mucosa have been proposed. Chromoendoscopy significantly increases the sensitivity of detecting subtle dysplastic
lesions and has emerged as the new standard of cancer surveillance in patients with IBD. Confocal laser endomicroscopy
(CLE) is a novel technique that enables the endoscopist to obtain real time in vivo microscopic images of the
gastrointestinal mucosa and can be used for targeting biopsies to relevant areas. CLE in conjunction with chromoendoscopy
proved able to increase the diagnostic yield of dysplasia in ulcerative colitis and reduce the number of biopsies
needed. The role of digital filtering technologies (virtual chromoendoscopy) and autofluorescence in IBD surveillance will
be also discussed.

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