Table 1

Seven guidelines (SURFACE) for chromoendoscopy in ulcerative colitis

    (1) Strict patient selection.
Patients with histologically proven ulcerative colitis and at least eight years’ duration in clinical remission. Avoid patients with active disease.
    (2) Unmask the mucosal surface.
Excellent bowel preparation is needed. Remove mucus and remaining fluid in the colon when necessary.
    (3) Reduce peristaltic waves.
When drawing back the endoscope, a spasmolytic agent should be used (if necessary).
    (4) Full length staining of the colon.
Perform full length staining of the colon (panchromoendoscopy) in ulcerative colitis rather than local staining
    (5) Augmented detection with dyes.
Intravital staining with 0.4% indigo carmine or 0.1% methylene blue should be used to unmask flat lesions more frequently than with conventional colonoscopy.
    (6) Crypt architecture analysis.
All lesions should be analysed according to the pit pattern classification. Whereas pit pattern types I–II suggest the presence of non-malignant lesions, staining patterns III–V suggest the presence of intraepithelial neoplasias and carcinomas.
    (7) Endoscopic targeted biopsies.
Perform targeted biopsies of all mucosal alterations, particularly of circumscript lesions with staining patterns indicative of intraepithelial neoplasias and carcinomas (pit patterns III–V).