Pal P, Kata P, Nabi Z, Ramchandani M, Soma PR, Gupta R, Tandan M, Duvvur NR. Advances in endoscopic dysplasia detection in inflammatory bowel disease. World J Gastrointest Endosc 2025; 17(12): 111236 [DOI: 10.4253/wjge.v17.i12.111236]
Corresponding Author of This Article
Partha Pal, MD, FASGE, MRCP, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Red Rose Cafe Lane, Sangeet Nagar, Somajiguda, Hyderabad 500082, India. partha0123456789@gmail.com
Research Domain of This Article
Medical Informatics
Article-Type of This Article
Systematic Reviews
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dec 16, 2025 (publication date) through Dec 19, 2025
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Journal Information of This Article
Publication Name
World Journal of Gastrointestinal Endoscopy
ISSN
1948-5190
Publisher of This Article
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Pal P, Kata P, Nabi Z, Ramchandani M, Soma PR, Gupta R, Tandan M, Duvvur NR. Advances in endoscopic dysplasia detection in inflammatory bowel disease. World J Gastrointest Endosc 2025; 17(12): 111236 [DOI: 10.4253/wjge.v17.i12.111236]
Partha Pal, Zaheer Nabi, Mohan Ramchandani, Pramod Reddy Soma, Rajesh Gupta, Manu Tandan, Nageshwar Reddy Duvvur, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad 500082, India
Priyaranjan Kata, Department of Medicine, MedStar St. Mary’s Hospital, Leonardtown, MD 20650, United States
Co-first authors: Partha Pal and Priyaranjan Kata.
Author contributions: Pal P, Ramchandani M, Gupta R, Tandan M, Duvvuru NR provided intellectual input; Kata P, Soma PR contribute to proof reading; Nabi Z, Ramchandani M, Soma PR, Gupta R, Tandan M, Duvvuru NR critically revised the manuscript; Gupta R, Tandan M supervised the literature search; Gupta R, Tandan M contribute to the writing; Pal P conceptualized the work, performed the literature search, wrote the first draft; Kata P performed first screening and editing; Nabi Z provided images, intellectual input; Kata P and Soma PR contribute to critical review and of manuscript; and Reddy DN supervised the writing; Pal P and Kata P contributed equally to the manuscript and are co-first authors.
Conflict-of-interest statement: Pal P received consultancy fees from Johnson and Johnson. Other authors have no relevant conflicts of interest to disclose relevant to the article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Partha Pal, MD, FASGE, MRCP, Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Red Rose Cafe Lane, Sangeet Nagar, Somajiguda, Hyderabad 500082, India. partha0123456789@gmail.com
Received: June 26, 2025 Revised: July 24, 2025 Accepted: October 24, 2025 Published online: December 16, 2025 Processing time: 173 Days and 15.5 Hours
Abstract
BACKGROUND
Dysplasia surveillance in inflammatory bowel disease (IBD) has evolved significantly with the adoption of advanced endoscopic technologies.
AIM
To synthesize evidence on image-enhanced endoscopy techniques, biopsy protocols, and surveillance practices optimizing dysplasia detection in IBD.
METHODS
A scoping review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A comprehensive search of PubMed and EMBASE from inception to June 2025 identified studies reporting on endoscopic dysplasia detection or characterization in IBD. Forty-five studies were included for qualitative synthesis, covering dye-based chromoendoscopy (DCE), virtual chromoendoscopy (VCE), confocal laser endomicroscopy, artificial intelligence-based tools, and panoramic endoscopy.
RESULTS
DCE consistently demonstrated high dysplasia detection rates, especially when indigo carmine was used, and enabled accurate pit-pattern-based lesion characterization. High definition (HD) DCE may offer procedural benefits over HD white light endoscopy (WLE), though superiority in dysplasia detection remains inconsistent across studies. In comparative studies, DCE outperformed or matched white-light approaches, with higher dysplasia yield in selected trials (e.g., 9.7% vs 1.9%, P = 0.004), while HD WLE with segmental re-inspection was non-inferior to DCE in expert settings. Virtual chromoendoscopy modalities such as i-SCAN and narrow band imaging showed comparable performance to DCE in several trials, with artificial intelligence-assisted computer-aided detection systems demonstrating equivalent sensitivity but lower specificity. Studies comparing biopsy protocols revealed that targeted biopsies under image-enhanced endoscopy, particularly DCE, were generally superior or equivalent to random biopsies, with random sampling offering marginal benefit in select high-risk subgroups. Multimodal imaging and panoramic endoscopy further improved dysplasia yield in challenging cases. Cost-effectiveness analyses favored DCE over WLE, and long-term surveillance data confirmed declining colorectal cancer rates with high-quality endoscopic programs. However, real-world practice audits revealed substantial variation in surveillance quality and guideline adherence.
CONCLUSION
Image-enhanced targeted surveillance - particularly using DCE or validated virtual platforms - has improved dysplasia detection in IBD and may allow for a reduction in random biopsies. Despite technological advancements, major quality gaps and interobserver variability persist in clinical practice. Standardized training, quality benchmarks, and cost-effective implementation of advanced endoscopic techniques are needed to optimize colorectal cancer prevention in IBD.
Core Tip: Dye-based chromoendoscopy (DCE), particularly with indigo carmine, provides high dysplasia detection rates and accurate lesion characterization in inflammatory bowel disease. While high-definition DCE may offer procedural advantages over high-definition white light endoscopy, detection superiority remains inconsistent. Virtual chromoendoscopy shows comparable dysplasia detection to DCE in several trials, with added efficiency and reduced procedure time. Targeted biopsies under image-enhanced endoscopy outperform or match random biopsies, with limited added value from random sampling except in select high-risk patients. Multimodal imaging and panoramic endoscopy enhance dysplasia yield. Despite strong evidence, real-world surveillance quality varies widely, highlighting the need for standardization.
