Present and future of endoscopy precision for inflammatory bowel disease

Abstract

Several advanced imaging techniques are now available for endoscopists managing inflammatory bowel disease (IBD) patients. These tools, including dye‐based and virtual chromoendoscopy, probe‐based confocal laser endomicroscopy and endocytoscopy, are increasingly innovative applications in clinical practice. They allow for a more in‐depth and refined evaluation of the mucosal and vascular bowel surface, getting closer to histology. They have demonstrated a remarkable ability in assessing intestinal inflammation, histologic remission, and predicting relapse and favorable long‐term outcomes. In addition, the future application of molecular endoscopy to predict biological drug responses has yielded preliminary but encouraging results. Furthermore, these techniques are crucial in detecting and characterizing IBD‐related dysplasia, assisting endoscopic mucosal resection and submucosal dissection towards a surgery‐sparing approach. Artificial intelligence (AI) holds great potential in this promising landscape, as it can provide an objective and reproducible assessment of inflammation and dysplasia. Moreover, it can improve the prediction of outcomes and aid in subsequent therapeutic decision‐making. This review aims to summarize the promising role of state‐of‐the‐art advanced endoscopic techniques and related AI‐enabled models for managing IBD, paving the way for precision medicine.

Endoscopic Management of Strictures in Crohn’s Disease: An Unsolved Case

“…Beyond EBD, in the last two decades, a wide range of alternative procedures have been gathering attention [8], with still limited data and a lack of standardization both in techniques and study designs [9]. In the era of precision endoscopy in inflammatory bowel disease (IBD), there is growing interest in advanced imaging techniques and 2 artificial intelligence tools to aid inflammation and dysplasia recognition and discriminate molecular patterns to target [10,11]; likewise, both the established and the potential therapeutic endoscopic tools promise to lead the management of stricturing CD to an increasingly microinvasive and personalized approach, with still several dark spots to be addressed and groundbreaking roads to be taken.…”