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Copyright ©The Author(s) 2016.
World J Gastroenterol. Jul 7, 2016; 22(25): 5642-5654
Published online Jul 7, 2016. doi: 10.3748/wjg.v22.i25.5642
Table 1 Recommendations and state-of-the-art in inflammatory bowel disease imaging according to international guidelines[15-18]
Initial diagnosis and follow-upColonoscopy with ileoscopy is recommended for the initial evaluation of inflammatory bowel disease (IBD) and for the differentiation IBD subtypes
Sampling of mucosal biopsy specimens from multiple sites during the initial endoscopic evaluation of IBD is recommended
Flexible sigmoidoscopy should be performed in patients with IBD when colonoscopy is contraindicated
Radiological imaging techniques are complementary to endoscopic assessment. Cross-sectional imaging offers the opportunity to detect and stage inflammatory, obstructive and fistulizing Crohn's disease (CD) and is fundamental at first diagnosis to stage disease and to monitor follow-up
Ultrasound (US) is a well-tolerated and radiation-free imaging technique, particularly for the terminal ileum and the colon. Examinations are impaired by gas-filled bowel and by large body habitus
US is able to detect signs of Crohn's disease and has high and comparable diagnostic accuracy at the initial presentation of terminal ileal CD
US can be used to assess disease activity in Crohn's disease of the terminal ileum
US imaging is an adjunct to endoscopy for diagnosis of colonic IBD
Transabdominal US has a high accuracy for assessing the activity and severity of Crohn’s colitis; the performance in UC is less clear; the accuracy of monitoring therapy in colonic Crohn's disease is not well defined
Surveillance and management of dysplasiaIt is recommended that all patients with UC or CD colitis undergo a screening colonoscopy 8 yr after disease onset to re-evaluate extent of disease and initiate surveillance for colorectal neoplasia
It is recommended to perform surveillance colonoscopy every 1 to 3 yr beginning after 8 yr of disease in patients with UC with macroscopic or histologic evidence of inflammation proximal to and including the sigmoid colon and for patients with Crohn’s colitis with greater than one-third of colon involvement
If white-light colonoscopy is performed in case of surveillance, high definition (HD) is recommended rather than standard definition (SD)
If surveillance is performed with SD colonoscopy, chromoendoscopy is recommended rather than white-light
If performing surveillance with HD colonoscopy, chromoendoscopy is suggested rather than white-light colonoscopy
If performing surveillance with SD colonoscopy, narrow-band imaging (NBI) is not suggested in place of white-light
If performing surveillance with high-definition colonoscopy, NBI is not suggested in place of white-light
If performing surveillance with image-enhanced HD colonoscopy, NBI is not suggested in place of chromoendoscopy
Management of dysplasia discovered on surveillance colonoscopyAfter complete removal of endoscopically resectable polypoid dysplastic lesions, surveillance colonoscopy is recommended rather than colectomy
After complete removal of endoscopically resectable nonpolypoid dysplastic lesions, surveillance colonoscopy is suggested rather than colectomy
For patients with endoscopically invisible dysplasia (confirmed by a gastrointestinal pathologist), referral is suggested to an endoscopist with expertise in IBD surveillance using chromoendoscopy with high-definition colonoscopy
Table 2 Assessment of disease activity with advanced endoscopic imaging in the context of clinical trials
Ref.TechniqueNo. of patientsFindings
Kiesslich et al[84], 2003CE165Agreement with histology: 84.5% (72 of 84) vs 60% (49 of 81)
Kudo et al[85], 2009NBI30Obscure mucosal vascular pattern is associated with inflammatory cell infiltrates (26% vs 0%), goblet cell depletion (32% vs 5%), and basal plasmacytosis (2% vs 21%)
Danese et al[87], 2010NBI14Positive appearance on NBI correlated with increase in angiogenesis or vessel density
Neumann et al[88], 2013Virtual CE (i-Scan)78Inflammatory extent and activity accordance with the histological results: 48.71% and 53.85% (white-light) and 92.31% and 89.74% (i-Scan)
Watanabe et al[89], 2008CLE17Distinct alterations in active and non-active UC patients compared to histology
Li et al[90], 2010CLE73Crypt architecture and fluorescein leakage with CLE correlate with histological results
Neumann et al[92], 2012CLE54CDEAS consisting of six parameters: crypt number, crypt distortion, micro erosions, cellular infiltrate, vascularity, and number of goblet cells
Strong correlation of CDEAS and CRP