| Theme | Update in management of colitic cancer | |
|---|---|---|
| Title | Detecting intraepithelial neoplasia in ulcerative colitis : Novel endoscopic techniques | |
| Publish Date | 2009/05 | |
| Author | David Paul Hurlstone | Department of Endoscopy, Barnsley NHS Foundation Trust |
| [ Summary ] | Approximately 1 in 6 patients with chronic ulcerative colitis will die as a result of colorectal malignancy, which can often be difficult to detect using conventional 'white light' colonoscopy. Detecting intraepithelial neoplasia and colitis associated colorectal cancer is extremely challenging in ulcerative colitis as the disease process itself causes gross changes in mucosal architecture. Dysplasia has therefore been used historically as a biomarker of underlying colorectal malignancy with current guidelines advocating 10 cm quadrantic random biopsy sampling. Interval cancers and late stage malignancy is well reported in this patient cohort despite currently operable surveillance practice. Furthermore, the diagnostic yield of intraepithelial neoplasia and colitisassociated cancer using this technique is poor and likely to be not cost effective. Recently, the introduction of chromoendoscopy and laser scanning confocal endomicroscopy has for the first time allowed live, surface cellular and sub-surface vascular imaging of the mucosa in real time during ongoing video-colonoscopy. Recent data suggests that this imaging modality may now offer a cost effective, sensitive and specific tool when used for the in vivo detection and characterisation of intraepithelial neoplasia and colitis associated colorectal cancer. Furthermore, it may also offer additional clinical benefit when used as an in vivo optical biopsy technique for the assessment of mucosal inflammatory parameters and disease extent assessment. Within this review, we appraise the current data pertinent to chromoendoscopy and endomicroscopy technology in ulcerative colitis surveillance and illustrate the potential clinical benefits. |
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