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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2015; 21(40): 11260-11272
Published online Oct 28, 2015. doi: 10.3748/wjg.v21.i40.11260
From the surface to the single cell: Novel endoscopic approaches in inflammatory bowel disease
Timo Rath, Gian Eugenio Tontini, Markus F Neurath, Helmut Neumann
Timo Rath, Gian Eugenio Tontini, Markus F Neurath, Helmut Neumann, Department of Medicine 1, Division of Gastroenterology, University Hospital Erlangen, 91054 Erlangen, Germany
Gian Eugenio Tontini, Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, 20097 San Donato Milanese, Italy
Author contributions: Rath T and Neumann H wrote the manuscript; Tontini GE and Neurath MF provided important intellectual content.
Conflict-of-interest statement: The authors have no conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Helmut Neumann, Professor, Department of Medicine 1, Division of Gastroenterology, University Hospital Erlangen, FAU Erlangen-Nuremberg, Ulmenweg 18, 91054 Erlangen, Germany. helmut.neumann@uk-erlangen.de
Telephone: +49-9131-8535204 Fax: +49-9131-8535209
Received: April 27, 2015
Peer-review started: May 4, 2015
First decision: July 20, 2015
Revised: July 31, 2015
Accepted: September 14, 2015
Article in press: September 15, 2015
Published online: October 28, 2015
Processing time: 178 Days and 19.2 Hours
Abstract

Inflammatory bowel diseases (IBD) comprise the two major entities Crohn’s disease and ulcerative colitis and endoscopic imaging of the gastrointestinal tract has always been an integral and central part in the management of IBD patients. Within the recent years, mucosal healing emerged as a key treatment goal in IBD that substantially decides about the clinical outcome of IBD patients, thereby demanding for a precise, timely and detailed endoscopic assessment of the mucosal inflammation associated with IBD. Further, molecular imaging has tremendously expanded the clinical utility and applications of modern endoscopy, now encompassing not only diagnosis, surveillance, and treatment but also the prediction of individual therapy response. Within this review we describe novel endoscopic approaches and advanced endoscopic imaging methods for the diagnosis, treatment and surveillance of IBD patients. We begin by providing an overview over novel and advanced imaging techniques such as magnification endoscopy and dye-based and dye-less chromoendoscopy, endomicroscopy and endocytoscopy. We then describe how these techniques can be utilized for the precise and ultrastructural assessment of mucosal inflammation and dysplasia development associated with IBD and outline how they have enabled the endoscopist to gain insight onto the cellular level in real-time. Finally, we provide an outlook on how molecular imaging has rapidly evolved in the recent past and can be used to make individual predictions about the therapeutic response towards biological treatment.

Keywords: Gastrointestinal endoscopy; Crohn’s disease; Ulcerative colitis; Inflammatory bowel diseases; Colon; Colorectal neoplasms

Core tip: Within this review we describe novel endoscopic techniques for the diagnosis, treatment and surveillance of inflammatory bowel diseases (IBD) patients. We begin by providing an overview over advanced imaging techniques such as magnification endoscopy, dye-based and dye-less chromoendoscopy, endomicroscopy and endocytoscopy. We then portray how these techniques provide insights on cellular level in real-time and how they can be utilized for the precise and ultrastructural assessment of mucosal inflammation and dysplasia development in IBD. Finally, we review how molecular imaging has rapidly evolved in the recent past and can now be used to make individual predictions about the therapeutic response towards biological treatment.