Malignant Transformation in Inflammatory Bowel Disease: Prevention, Surveillance and Treatment – New Techniques in Endoscopy

Abstract

Patients with a long-standing history of ulcerative colitis (UC) or Crohn’s disease (CD) with a history of inflammation in the colon have a risk for the development of colon cancer. To these patients at least one colonoscopy per year should be offered according to national surveillance guidelines in patients with inflammatory bowel disease (IBD). Following general recommendations, surveillance colonoscopy should be performed without disease activity and four tissue samples each 10 cm should be taken. Beside high-resolution videoendoscopy and magnification endoscopy, the application of dyes applied via a spraying catheter are of additional diagnostic value with a factor 3–4 higher detection rate of intraepithelial neoplasia (IEN). It is under current evaluation if the use of computerized virtual chromoendoscopy techniques (NBI, FICE, High Line/HD+) has the same diagnostic output compared to classical spraying techniques. The detection rate of IEN can be further improved by using newly developed in-vivo histology techniques. A combination of chromoendoscopy with confocal endomicroscopy (CEM) can detect 5-fold higher rates of IEN compared with random biopsy protocols. An alternative technique to CEM is the miniprobe-based CEM. Autofluorescence imaging is an interesting approach for the surveillance of IBD patients with first clinical data published.

Imaging of colorectal polyps and early rectal cancer

“…CTC should be also avoided in the surveillance of patients with ulcerative colitis or Crohn's disease and Hereditary Non‐Polypoid Colorectal Cancer (HNPCC) and APC‐Associated Polyposis Conditions. Because of the increased risk of developing CRC in these conditions, colonoscopy should be preferred .…”

Detection of DSS-induced gastrointestinal mucositis in mice by non-invasive optical near-infrared (NIR) imaging of cathepsin activity

“…36 Potentially, given the link between cathepsin excretion and colorectal cancer, optical imaging might also aid in detecting and directing colonoscopic biopsy sampling in the diagnosis of both inflammatory lesions and colonic neoplasms. Further experiments are required to address the potential of clinical translation of NIR-optical imaging of cathepsin-activity for the benefit of IBD-patients.…”

Colorectal cancer surveillance in patients with inflammatory bowel disease: What ¡s new?

“…through a 2.8 mm work channel of any standard videoendoscope, the laser unit generates a confocal image with a high frame rate per second. Studies comparing this technique with others are currently being evaluated and there are no available data with regard to IBD patients [67] . Narrow band imaging (NBI) is another innovative technique that can provide clear imaging of the microvascular mucosal structure as a result of the differential optical absorption of light by hemoglobin [68] .…”