Tomašić V, Ćaćić P, Baršić N, Bišćanin A. Beyond conventional endoscopy: Image-enhanced techniques in quiescent ulcerative colitis assessment. World J Gastrointest Endosc 2026; 18(1): 113749 [DOI: 10.4253/wjge.v18.i1.113749]
Corresponding Author of This Article
Vedran Tomašić, MD, PhD, Consultant, Lecturer, Department of Endoscopy and Day Hospital, Klinički bolnički Centar Sestre Milosrdnice, Vinogradska Cesta 29, Zagreb 10000, Croatia. tomasicvedran@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Minireviews
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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/
World J Gastrointest Endosc. Jan 16, 2026; 18(1): 113749 Published online Jan 16, 2026. doi: 10.4253/wjge.v18.i1.113749
Beyond conventional endoscopy: Image-enhanced techniques in quiescent ulcerative colitis assessment
Vedran Tomašić, Petra Ćaćić, Neven Baršić, Alen Bišćanin
Vedran Tomašić, Alen Bišćanin, Department of Endoscopy and Day Hospital, Klinički bolnički Centar Sestre Milosrdnice, Zagreb 10000, Croatia
Petra Ćaćić, Neven Baršić, Department of Gastroenterology and Hepatology, Klinički bolnički Centar Sestre Milosrdnice, Zagreb 10000, Croatia
Neven Baršić, Alen Bišćanin, Department of Internal Medicine, University of Zagreb School of Medicine, Zagreb 10000, Croatia
Author contributions: Tomašić V provided the review’s conceptualization; Tomašić V and Ćaćić P performed the data acquisition and wrote the original draft; Tomašić V, Ćaćić P, Baršić N, and Bišćanin A participated in the review and editing of all successive versions of the manuscript. All authors approval the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Vedran Tomašić, MD, PhD, Consultant, Lecturer, Department of Endoscopy and Day Hospital, Klinički bolnički Centar Sestre Milosrdnice, Vinogradska Cesta 29, Zagreb 10000, Croatia. tomasicvedran@gmail.com
Received: September 2, 2025 Revised: October 11, 2025 Accepted: November 21, 2025 Published online: January 16, 2026 Processing time: 135 Days and 5.8 Hours
Abstract
Mucosal healing is an important therapeutic target in ulcerative colitis (UC) because it is associated with improved clinical outcomes and sustained remission. Conventional white-light endoscopy has limitations, including subjective interpretation, interobserver variability, and difficulty detecting residual microscopic inflammation despite an apparently healed mucosa. Image-enhanced endoscopy (IEE) techniques improve visualization of mucosal and vascular patterns, potentially enhancing the assessment of inflammation and healing in UC. Modalities such as narrow-band imaging, linked-color imaging, blue laser imaging, dual-red imaging, texture and color enhancement imaging, and iSCAN accentuate vascular structures and subtle color differences, allowing more precise differentiation between complete and partial healing. These methods correlate strongly with histological inflammation and better predict clinical relapse compared with conventional scoring systems such as the Mayo Endoscopic Subscore. Quantitative IEE-based indices, including the linked-color imaging index, Paddington International virtual ChromoendoScopy ScOre, and Mucosal Analysis of Inflammatory Gravity by iScan TE-c Image score, provide reproducible and objective measurements that reduce subjective variability. Next-generation endoscopic platforms combining advanced IEE technologies enable real-time, high-resolution evaluation of mucosal microarchitecture and vascular regeneration. This facilitates personalized management by detecting residual inflammation earlier, improving monitoring, optimizing treatment decisions, and ultimately enhancing long-term outcomes while lowering relapse rates in UC patients.
Core Tip: Endoscopic-histological correlations in ulcerative colitis were previously inconsistent because conventional white-light endoscopy often missed subtle mucosal and vascular changes, leading to underestimation of patchy inflammation. Discrepancies also arose from sampling variability, patchy healing, unstandardized protocols, and inconsistent scoring systems. Advanced endoscopic technologies now enhance visualization of mucosal and vascular features, allowing more accurate assessment of disease activity that aligns closely with histology and supports improved long-term outcomes. These advances are driving the field of precision endoscopy in ulcerative colitis, with the potential to improve diagnostic accuracy and monitoring of treatment response.
