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Advanced endoscopic techniques in the assessment of inflammatory bowel disease: new technology, new era
  1. Marietta Iacucci1,2,3,4,
  2. Federica Furfaro5,
  3. Takayuki Matsumoto6,
  4. Toshio Uraoka7,
  5. Samuel Smith1,2,
  6. Subrata Ghosh1,2,3,
  7. Ralf Kiesslich8
  1. 1 National Institute for Health Research (NIHR), Birmingham Biomedical Research Centre, Birmingham, UK
  2. 2 Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
  3. 3 Department of Gastroenterology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
  4. 4 Department of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
  5. 5 IBD Centre, Humanitas Research Hospital, Milan, Italy
  6. 6 Department of Gastroenterology, Iwate Medical University, Morioka, Japan
  7. 7 Department of Gastroenterology and Hepatology, Gumna University Graduate School of Medicine, Maebashi, Japan
  8. 8 Department of Medicine, HSK Hospital, Wiesbaden, Germany
  1. Correspondence to Dr Marietta Iacucci, Institute of Translational Medicine and Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham B15 2TH, UK; iacuccim{at}


Endoscopic assessment of inflammation and mucosal healing is crucial for appropriate management in IBD. Current definition of endoscopic mucosal healing has been derived using previous generation of standard white light endoscopes. New endoscopy technologies widely available provide much more detailed images of mucosal and vascular patterns. Novel endoscopic techniques with high definition image, optical and digital enhancement have enhanced the quality and fine details of vascular and mucosal pattern so that endoscopic images have started to reflect histological changes for lesions and inflammation/healing. These technologies can now define subtle inflammatory changes and increase detection and characterisation of colonic lesions in patients with IBD. The best endoscopic technique to detect dysplasia in IBD is still debated. Dye chromoendoscopy with targeted biopsies is considered by Surveillance for Colorectal Endoscopic Neoplasia Detection and Management in inflammatory Bowel Disease Patients: International Consensus Recommendations (SCENIC consensus the standard of care and recommended for adoption by gastroenterologists in practice. In future, it is possible that well-trained colonoscopists using high definition equipment with image enhancements may be able to obtain equivalent yield without pan-colonic dye spraying and characterise lesions. Finally, SCENIC introduced endoscopic resectability of some dysplastic colonic lesions—new techniques may now better characterise endoscopic resectability and limit the number of colectomies. In this review, we will provide a state-of-the-art opinion on the direction of technological advances in the assessment of IBD and how new concepts will refine clinical practice.

  • chronic diarrhoea
  • functional bowel disorder
  • endoscopy

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  • FF, SG and RK contributed equally.

  • Contributors MI, SG and RK planned the manuscript and created the first draft. MI and all coauthors contributed to the content of the manuscript and figures, and reviewed, edited and approved the final draft.

  • Funding MI and SG are funded by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham.

  • Competing interests MI: received research support from Pentax, Olympus and Fujifilm; Speaker fees from Pentax. SG: Received speaker fees from Abbvie, Janssen, Takeda.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.