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Endocytoscopy is noninferior to standard biopsy for the discrimination of neoplastic lesions. With its advantage of providing an on-site diagnosis, endocytoscopy could provide a novel alternative to standard biopsy in routine colonoscopy.

Background and AimEndocytoscopy (EC) at ultra-high magnification enables in vivo visualization of cellular atypia of gastrointestinal mucosae. Clear images are essential for precise diagnosis by EC. The aim of the present study was to evaluate the optimal staining method for EC in the colon.MethodsThirty prospectively enrolled patients were allocated 1:1:1 to three distinct staining methods: 0.05% crystal violet (CV) alone, 1% methylene blue (MB) alone, or CV + MB (CM double). Normal rectal mucosae were stained with each dye and videos of EC images were recorded. Visibility of nuclei and gland formation after staining were evaluated as ‘recognizable’ or ‘not recognizable’. Time for each parameter to become ‘recognizable’ was measured, and the average times for the three staining regimens were compared.ResultsMB alone and CM double staining resulted in ‘recognizable’ (102 ± 27 vs 89 ± 22 s, P = 0.263) nuclei within comparable periods of time, whereas CV alone was unable to identify nuclei. Gland formation became ‘recognizable’ sooner after CM double staining than after MB alone (61 ± 16 vs 108 ± 24 s, P < 0.001).ConclusionsDouble staining with CV and MB, which rapidly provided recognizable images of both nuclei and gland formation, is an appropriate staining regimen for colonic EC.

AIM:To assess the efficacy of endocytoscopic narrowband imaging (EC-NBI) for evaluating the severity of inflammation in ulcerative colitis (UC). METHODS:This retrospective study was conducted at a single tertiary care referral center. We included UC patients who underwent colonoscopy with endocytoscopy from July 2010 to December 2013. EC-NBI was performed, and the images were evaluated by assessing visibility, increased vascularization, and the increased calibers of capillaries and were classified as Obscure, Visible or Dilated. Obscure was indicative of inactive disease, while Visible and Dilated were indicative of acute inflammation. This study received Institutional Review Board approval. The primary outcome measures included the diagnostic ability of EC-NBI to distinguish between active and inactive UC on the basis of histological activity. The conventional endoscopic images were classified according to the Mayo endoscopic score. A score of 0 or 1 indicated inactive disease, whereas a score of 2 indicated active disease. RESULTS:Fifty-two patients were enrolled. There was a strong correlation between the EC-NBI findings and the histological assessment (r = 0.871, P < 0.01).The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EC-NBI for diagnosing acute inflammation were 84.0%, 100%, 87.1%, 100%, and 92.3%, respectively, while those for the Mayo endoscopic score were 100%, 40.7%, and accuracy (P < 0.001, P = 0.001 and P = 0.047, respectively). CONCLUSION:The EC-NBI finding of capillaries in the rectal mucosa was strongly correlated with histological inflammation and aided in the differential diagnosis between active and inactive UC.

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