Advanced endoscopic imaging for dysplasia surveillance in ulcerative colitis

Ulcerative colitis is a well-characterized chronic inflammatory bowel disease with a significantly increased risk for developing colorectal neoplasia. A rigorous colonoscopy surveillance program has been shown to undoubtedly reduce this risk. White light endoscopy with random 4-quadrant biopsies in addition to target biopsies of suspicious lesions has been considered the standard of care. However, interval cancers between successive surveillance colonoscopies have been identified. Recently, multiple new endoscopic imaging technologies such as standard chromoendoscopy with methylene blue, virtual chromoendoscopy, autofluorescence imaging, confocal laser endomicroscopy and endocytoscopy were developed to provide a more detailed visualization of the mucosa by enhancing morphology and vascularization. This review will provide a comprehensive approach to advanced endoscopic imaging useful for dysplasia surveillance in longstanding ulcerative colitis patients.