Malignant transformation in inflammatory bowel disease: prevention, surveillance and treatment - new techniques in...

Patients with a long-standing history of ulcerative colitis (UC) or Crohn's disease (CD) with a history of inflammation in the colon have a risk for the development of colon cancer. To these patients at least one colonoscopy per year should be offered according to national surveillance guidelines in patients with inflammatory bowel disease (IBD). Following general recommendations, surveillance colonoscopy should be performed without disease activity and four tissue samples each 10 cm should be taken. Beside high-resolution videoendoscopy and magnification endoscopy, the application of dyes applied via a spraying catheter are of additional diagnostic value with a factor 3-4 higher detection rate of intraepithelial neoplasia (IEN). It is under current evaluation if the use of computerized virtual chromoendoscopy techniques (NBI, FICE, High Line/HD+) has the same diagnostic output compared to classical spraying techniques. The detection rate of IEN can be further improved by using newly developed in-vivo histology techniques. A combination of chromoendoscopy with confocal endomicroscopy (CEM) can detect 5-fold higher rates of IEN compared with random biopsy protocols. An alternative technique to CEM is the miniprobe-based CEM. Autofluorescence imaging is an interesting approach for the surveillance of IBD patients with first clinical data published.