Advances in the Endoscopic Assessment of Inflammatory Bowel Diseases: Cooperation between Endoscopic and Pathologic Evaluations

Endoscopic assessment has a crucial role in the management of inflammatory bowel disease (IBD). It is particularly useful for the assessment of IBD disease extension, severity, and neoplasia surveillance. Recent advances in endoscopic imaging techniques have been revolutionized over the past decades, progressing from conventional white light endoscopy to novel endoscopic techniques using molecular probes or electronic filter technologies. These new technologies allow for visualization of the mucosa in detail and monitor for inflammation/dysplasia at the cellular or sub-cellular level. These techniques may enable us to alter the IBD surveillance paradigm from four quadrant random biopsy to targeted biopsy and diagnosis. High definition endoscopy and dye-based chromoendoscopy can improve the detection rate of dysplasia and evaluate inflammatory changes with better visualization. Dye-less chromoendoscopy, including narrow band imaging, iScan, and autofluorescence imaging can also enhance surveillance in comparison to white light endoscopy with optical or electronic filter technologies. Moreover, confocal laser endomicroscopy or endocytoscopy have can achieve real-time histology evaluation in vivo and have greater accuracy in comparison with histology. These new technologies could be combined with standard endoscopy or further histologic confirmation in patients with IBD. This review offers an evidence-based overview of new endoscopic techniques in patients with IBD.

High definition endoscopy and "narrow band imaging" in the diagnosis of gastroesophageal reflux disease / Diagnostico da doenca do refluxo gastroesofagico com endoscopia de alta definicao e "narrow band imaging"

Introduction: The gastroesophageal reflux disease is a common condition in the western world but less than half of patients present endoscopic abnormalities, making a standard procedure unsuitable for diagnosis. High definition endoscopy coupled with narrow band imaging has shown potential for differentiation of lesions and possible biopsy, allowing early diagnosis and treatment. Methods: This review describes the principles of biotic and their influence in obtaining images with better definition of the vessels in the mucosa, through the narrow band imaging. Selected papers using it in patients with reflux disease and Barrett's esophagus are analyzed in several ways, highlighting the findings and limitations. Conclusion: The meaning of the narrow band imaging in the endoscopic diagnosis of reflux disease will be defined by large scale studies, with different categories of patients, including assessment of symptoms and response to treatment. .

Introdução: A doença do refluxo gastroesofágico é condição altamente prevalente no mundo ocidental, porém, em menos da metade dos pacientes há alguma alteração endoscópica, indicando que a endoscopia convencional não é o procedimento ideal para o diagnóstico da doença do refluxo gastroesofágico. A endoscopia com aparelhos de alta definição associado ao dispositivo "narrow band imaging" tem demonstrado aplicação na diferenciação de lesões benignas das malignas e a possibilidade de direcionar as biópsias, permitindo diagnóstico e tratamento especialmente nos casos de câncer precoce. Método: Esta revisão descreve os princípios ópticos e sua influência na obtenção de imagens de vasos na mucosa, através da "narrow band imaging". Foram utilizados os descritores para pesquisa no PubMed e as publicações analisadas em diversos aspectos com destaque para o "narrow band imaging", seus fundamentos, aplicações e limitações. Conclusão: O significado do "narrow band imaging" no diagnóstico endoscópico da doença do refluxo gastroesofágico será definido por estudos em larga escala, com categorias diferentes de pacientes, incluindo avaliação de sintomas e resposta ao tratamento. .