Advanced Colonoscopy Techniques in Inflammatory Bowel Diseases

Colonoscopy in inflammatory bowel diseases is an essential tool for the diagnosis and assessment of the disease (UC and colonic CD), to detect dysplasia and endoscopic resection of colonic lesions. The assessment of the disease has dramatically improved in the last decade due to technological advances. These have resulted in high definition and virtual chromoendoscopy images incorporated in the new generation scopes, thereby enhancing mucosal and vascular pattern. Confocal laser endomicroscopy (CLE) and endocytoscopy are evolving endoscopic techniques that allow a deeper analysis of the intestinal mucosa at ultrastructural levels. Therefore, endoscopy is getting closer to histology. For surveillance colonoscopy, dye chromoendoscopy with targeted biopsies is the recommended technique by major guidelines. However, the recent European Society of Gastrointestinal Endoscopy guidelines suggest using virtual chromoendoscopy (VCE) for surveillance if the endoscopist is well-trained. Moreover, advanced techniques may help the development of therapeutic strategy. Finally, the computer-aided diagnosis systems are emerging as new tools in IBD patients. In this chapter, we will explain and analyze the role of advanced techniques in IBD patients and what it is new at the horizon.