Revue : Possibilités des nouvelles techniques endoscopiques : coloration vitale et endomicroscopie confocalein vivo dans la détection des lésions précancéreuses et du cancer précoce chez les patients porteurs de colite ulcéreuse
Review : Potential of new endoscopic techniques : intravital staining and in vivo confocal endomicroscopy for the detection of premalignant lesions and early cancer in patients with ulcerative colitis
The goal of every surveillance endoscopy in patients with long-standing ulcerative colitis is the early diagnosis of malignant and premalignant changes of the mucosa. Chromo-and magnifying endoscopes are exciting new tools and offer detailed analysis of the colonic mucosal surface and pit pattern architecture. This review summarises recent advances in endoscopic characterisation of colorectal lesions using magnification endoscopy and chromoendoscopy in patients with ulcerative colitis. Surface analysis of the colon using chromoendoscopy allows a prediction between non-neoplastic and neoplastic lesions with high specificity. Patients with longstanding ulcerative colitis have a valuable benefit if targeted biopsies are performed to detect intraepithelial neoplasias after panchromoendoscopy. Although there is a long learning curve, chromoendoscopy should thus belong to every endoscopists armamentarium. However, detailed knowledge about the technique, dyes, and specific staining patterns are mandatory before the yield of screening or surveillance colonoscopy can be increased.
A recent developed confocal endomicroscope which is an implement in the distal tip of a conventional video endoscope allows to examine cellular and subcellular details in vivo. This new technique enables virtual histology during ongoing colonoscopy and helps to achieve a rapid diagnosis.
The new techniques of magnifying chromoendoscopy and confocal laser endoscopy are parts of a new era where new optical developments will allow a unique look on surface and cellular structures.
R. KIESSLICH, M.F. NEURATH
chromoendoscopy, magnifying endoscopy, confocal laser endomicroscopy, ulcerative colitis, dysplasia, neoplasia