Confocal endomicroscopy and other image-enhanced endoscopy in inflammatory bowel disease

Assessment of disease activity in inflammatory bowel disease and surveillance of colitis-associated neoplasia has benefited from advances in image-enhanced endoscopy. Confocal laser endomicroscopy (CLE) and endocytoscopy allow for real-time visualization of cellular architecture details of the gastrointestinal tract, further defining endoscopic mucosal healing or mild disease activity and guiding targeted biopsy for the disease monitoring as well as dysplasia surveillance. CLE and endocytoscopy are valid tools for both structural and functional assessment of the intestinal epithelium. CLE or endocytoscopy has even been proposed as a tool for optical biopsy. Magnification endoscopy equipped with the latest models of white-light endoscopy can highlight the mucosal structure and subepithelial microvasculature, especially in combined use with dye-based chromoendoscopy or narrow-band imaging. Optical coherence tomography has been used for the assessment of disrupted layered structures of bowel wall in the differential diagnosis between Crohn’s disease and ulcerative colitis. We expect that the development of probe-based ultrasound elastography will help the distinction between inflammatory and fibrotic strictures.