Seeing more clearly: a new era of ulcerative colitis surveillance

Dye-spraying and new endoscope technology has ended the era of random multiple biopsies in colonoscopy surveillance in ulcerative colitis. It has already been shown that chromoscopy unmasks significant lesions in flat mucosa and increases the number of neoplasia detected. Magnification endoscopy, narrow-band imaging and confocal laser endomicroscopy offer the possibility of in vivo lesion recognition, to increase the accuracy of distinguishing neoplastic from non-neoplastic lesions without biopsy.

Kiesslich et al randomised 161 long-term patients with ulcerative colitis to undergo either conventional colonoscopy (with quadrantic biopsies every 10 cm) or chromoscopy with endomicroscopy. In this latter group, patients received intravenous fluorescein to allow confocal laser endomicroscopy using a Pentax instrument. On withdrawal, 30 cm segments of colon were sprayed with 0.1% methylene blue and excess dye was removed by suction. Identified lesions were examined by endomicroscopy (not interfered with by dye spraying). Lesions were then graded by crypt or vessel architecture as normal, regenerative or neoplastic. Lesions were also scored for severity of inflammation. Biopsies were then taken from all lesions.

Eight patients were excluded for poor bowel preparation and only 25% of patients had pancolitis (significantly more in the conventional colonoscopy group). However, significantly …