43, 44 and 45 AFI endoscopy has been reported to be promising for the detection of dysplasia in UC,43, 44 and 45 although the clinical potential of AFI in routine colonoscopy has been complicated by high false-positive detection rates, particularly in cases of NP-CRN (see Table 2). Van den Broek and colleagues44 reported that AFI endoscopy improves the diagnosis

of dysplasia in patients with UC. However, the interpretation of the results should be done with caution because the study initially excluded patients with active inflammation. Because AFI is attenuated in colonic inflammation as well as in neoplasm, such exclusion seems to have contributed positively to the assessment of AFI endoscopy by decreasing the number of false-positive areas. Matsumoto and colleagues45 reported that AFI endoscopy identified 14 dysplasias in 4 FK228 mw patients during surveillance colonoscopy of 48 patients with UC. Eleven lesions were polypoid lesions, and the other 3 lesions were flat lesions. Autofluorescence as determined by AFI was regarded to be low in 12 lesions and to be normal in 2 lesions. Thus, the specificity of AFI endoscopy for the detection of flat dysplasia was, in fact, less than those of the prior investigations by NBI endoscopy or chromoendoscopy.44 and 45 This finding seems to be a consequence of patchy inflammation in the observed area because autofluorescence under AFI endoscopy

http://www.selleckchem.com/products/INCB18424.html was altered according to the grade of inflammation in patients with UC. In order to use AFI for surveillance colonoscopy in patients with UC, it is necessary to express autofluorescence numerically and objectively and to clarify the discrimination between the inflammation and neoplastic lesions. There have not been any large trials on the usefulness of AFI for the detection of colitis-associated dysplasia and cancer. AFI may have great potential for the detection of non–polypoid colitis–associated dysplasia and cancer without magnification. Most NP-CRNs are visible, and their detection can be facilitated by the use of chromoendoscopy. Chromoendoscopy using indigo

carmine, in turn, also augments the further evaluation of the border and surface pattern of the lesion. Magnifying Mannose-binding protein-associated serine protease endoscopy can assist in further visualizing the surface pattern, although chronic inflammation and its sequela in patients with IBD make the use of the pit pattern analysis less useful. In Japan, at present, efforts are given to clarify the merit for random biopsy. A nationwide randomized controlled trial is ongoing to clarify whether target biopsy or random step biopsy is effective for the detection of NP-CRN.67 “
“Chromoendoscopy increases dysplasia detection in ulcerative colitis, and can be implemented across solo and group practices. Image-enhanced colonoscopy using chromoendoscopy (CE) with targeted biopsy has been shown to significantly improve dysplasia detection in inflammatory bowel disease (IBD) colitis.