Recent advances in the endoscopic assessment of ulcerative colitis

Endoscopic assessment of the severity and extent of inflammation as well as the presence of neoplastic lesions is integral to the management of ulcerative colitis (UC). Numerous scoring systems to assess endoscopic severity indicate that a perfect scoring system is still lacking. Many of the scoring systems were designed in the era of standard-definition white-light endoscopy. The resolution and details provided by the new-generation endoscopes and high-definition equipment of both mucosal pattern and vascular pattern mandates a fresh look at endoscopic scoring in UC. In this context, we describe some of the scoring systems recently designed using novel endoscopic techniques. Current definitions of mucosal healing do not completely reflect histologic healing but this gap is being closed rapidly by novel endoscopic techniques with high-definition images that can be optically and digitally enhanced. The best technique to detect dysplasia in UC is still widely debated. New endoscopic resection techniques may now be able to limit the number of colectomies that need to be performed in the presence of dysplasia owing to improvement in performing local resection.