Use of advanced endoscopic technology for optical characterization of neoplasia in patients with ulcerative colitis: Systematic review

Abstract

Objectives: Advances in endoscopic technology, including magnifying and image-enhanced techniques, have been attracting increasing attention for the optical characterization of colorectal lesions. These techniques are being implemented into clinical practice as cost-effective and real-time approaches. Additionally, with the recent progress in endoscopic interventions, endoscopic resection is gaining acceptance as a treatment option in patients with ulcerative colitis (UC). Therefore, accurate preoperative characterization of lesions is now required. However, lesion characterization in patients with UC may be difficult because UC is often affected by inflammation, and it may be characterized by a distinct "bottom-up" growth pattern, and even expert endoscopists have relatively little experience with such cases. In this systematic review, we assessed the current status and limitations of the use of optical characterization of lesions in patients with UC.Methods: A literature search of online databases (MEDLINE via PubMed and CENTRAL via the Cochrane Library) was performed from 1 January 2000 to 30 November 2021. Results:The database search initially identified 748 unique articles. Finally, 25 studies were included in the systematic review: 23 focused on differentiation of neoplasia from nonneoplasia, one focused on differentiation of UC-associated neoplasia from sporadic neoplasia, and one focused on differentiation of low-grade dysplasia from high-grade dysplasia and cancer.Conclusions: Optical characterization of neoplasia in patients with UC, even using advanced endoscopic technology, is still challenging and several issues remain to be addressed. We believe that the information revealed in this review will encourage researchers to commit to the improvement of optical diagnostics for UC-associated lesions.

Histopathological Evaluation of Pouch Neoplasia in Inflammatory Bowel Diseases and Familial Adenomatous Polyposis

“…27,28 On endoscopy, these lesions tend to be flat and may be invisible. 2,[29][30][31] The occult nature of these lesions may allow them to progress while evading detection and removal for a relatively long period. At least one report suggests that "bottom-up" dysplasia in patients with UC may advance to carcinoma at a higher rate than conventional "top-down" dysplasia.…”

Personalize, participate, predict, and prevent: 4Ps in inflammatory bowel disease

“…Small but clinically relevant non pedunculated colorectal lesions are often overlooked during surveillance colonoscopy due to their subtle or inflammatory-like appearance ( 192 ). In addition, the optical characterization of neoplasia is still challenging in IBD colitis, even using advanced endoscopic technology in expert hands ( 193 ). Within this context, the future goal of artificial intelligence is the detection and characterization of colitis-associated dysplasia at an early stage, revealing non advanced colorectal lesions when still suitable for curative endoscopic resection or for timely prophylactic surgery based on a patient-tailored multidisciplinary approach ( 194 ).…”

Artificial intelligence in digestive endoscopy: recent advances

“…This point is important in clinical practice as endoscopic healing as histological are associated with an improving prognostic. In such condition, AI avoid multiple and time-consuming biopsies [4].…”

“…(3) CADx for optical characterization of neoplasia in patient with ulcerative colitis [4]. (4) AI systems to help making decisions as to whether additional surgery is needed after an endoscopic resection of T1 CRCs or no, by predicting lymph node metastasis [5].…”