Advances in endoscopic dysplasia detection in inflammatory bowel disease

Table 1 Summary of studies on individual techniques of dysplasia detection in inflammatory bowel disease

Ref.	Endoscopy method	Key findings
Rubín de Célix et al[6], 2021	Dye-based Chromoendoscopy (Indigo carmine)	24% dysplasia detection rate; high yield in flat and right-sided lesions; lesions > 5 mm and age > 60 were risk factors
Klepp et al[5], 2018	Dye-based Chromoendoscopy (Indigo carmine)	10.5% dysplasia detection rate; 20.8% yield with targeted vs 3.5% with random biopsies; high NPV (97%)
Wanders et al[7], 2016	Chromoendoscopy + confocal laser endomicroscopy (iCLE)	9.8% dysplasia detection rate; low sensitivity (42.9%); frequent equipment failures limited routine use
Matsumoto et al[8], 2007	Narrow band imaging + magnification	Tortuous pattern correlated with dysplasia; 80% sensitivity; high specificity (84.2%)
Guo et al[9], 2021	Narrow band imaging + mucosal vascular pattern analysis	MVP correlates with histological inflammation and Ki-67 index; useful for predicting mucosal proliferation
Yoshioka et al[10], 2016	AFI + NBI + CE	AFI green/red ratio predicted dysplasia; only 37.5% neoplastic lesions visible as purple; AFI quantitation promising

NPV: Negative predictive value; iCLE: Integrated confocal laser endomicroscopy; MVP: Mucosal vascular pattern; AFI: Autofluorescence imaging; CE: Chromoendoscopy; NBI: Narrow band imaging.

Table 2 Comparison of conventional/high definition colonoscopy and dye chromoendoscopy for dysplasia detection in inflammatory bowel disease

Ref.	Techniques compared	Study design	Key findings
Alexandersson et al[16], 2020	HD WLE vs HD DCE	RCT, 305 IBD patients	HD DCE detected dysplasia in 14% vs 6% with HD WLE (P = 0.020); superior for macroscopic dysplasia and lesions per 10-minute withdrawal
Carballal et al[2], 2018	HD WLE vs HD DCE (real-life)	Prospective real-world cohort	Dysplasia detection: 11.5% with CE vs 2.6% with WLE; CE significantly improved detection, mostly by targeted biopsies
Coelho-Prabhu et al[17], 2021	HD WLE vs HD DCE	Prospective observational	No significant difference in dysplasia detection; CE associated with longer procedure time
Yang et al[15], 2019	HD WLE (random) vs HD DCE (targeted)	Multicenter RCT	No significant difference in CAD detection (3.9% CE vs 5.6% WLE); CE reduced the number of biopsies
Kiesslich et al[18], 2003	SD WLE vs CE (Indigo carmine)	RCT	CE detected 32 lesions vs 10 lesions with WLE (P < 0.005); more flat/invisible dysplasia
Marion et al[19], 2008	SD WLE vs DCE	Prospective single-center	CE detected more dysplasia and additional lesions missed by WLE
Mooiweer et al[20], 2015	SD WLE + random biopsies vs DCE + targeted	Multicenter retrospective	No significant difference in dysplasia detection (11% vs 10%, P = 0.80)
Marion et al[21], 2016	SD WLE vs DCE	Prospective follow-up	CE did not increase detection in patients with prior negative colonoscopy
Freire et al[22], 2014	SD WLE vs DCE	RCT in UC patients	CE had higher dysplasia detection (28.2% vs 11.6%, P = 0.01)
Wan et al[23], 2021	SD WLE (targeted) vs DCE (targeted)	Multicenter RCT, long-term follow-up	CE superior for long-term surveillance (9.7% vs 1.9%, P = 0.004); detected more non-polypoid lesions
Te Groen M et al[24], 2025	HD WLE with segmental re-inspection vs HD DCE	Multicenter RCT (HELIOS)	HD WLE with re-inspection was non-inferior to HD DCE (10.3% vs 13.1%) for dysplasia detection

HD: High definition; WLE: White light endoscopy; DCE: Dye-based chromoendoscopy; SD: Standard definition; CE: Chromoendoscopy; RCT: Randomized controlled trial; IBD: Inflammatory bowel disease; UC: Ulcerative colitis; CAD: Colitis-associated dysplasia.

Table 3 Comparative studies of virtual chromoendoscopy, white light endoscopy, and artificial intelligence-assisted detection for dysplasia surveillance in inflammatory bowel disease

Ref.	Techniques compared	Study design	Key findings
Kandiah et al[25], 2021	VCE (i-SCAN OE) vs HD WLE	Multicenter RCT (VIRTUOSO trial)	VCE non-inferior to HD WLE for neoplasia detection; improved dysplasia characterization and fewer random biopsies
van den Broek et al[26], 2011	NBI vs HD WLE	Randomized crossover trial	No significant difference in neoplasia detection (NBI 81% vs HDE 69%, P = 0.727); NBI did not improve real-time differentiation
Dekker et al[27], 2007	NBI vs SD WLE	Prospective observational	NBI had limited sensitivity and specificity for dysplasia; not superior to WLE in UC surveillance
Leifeld et al[28], 2015	NBI vs SD WLE	RCT in UC patients	No significant difference in neoplasia detection; NBI had poor correlation with histology
López-Serrano et al[29], 2025	VCE with iSCAN vs CADe	Prospective, cross-sectional, non-inferiority diagnostic test comparison	Similar dysplasia detection (15.4% vs 13.5%); equal sensitivity (90%); VCE had better specificity and diagnostic accuracy

VCE: Virtual chromoendoscopy; i-SCAN OE: I-SCAN optical enhancement; HD: High definition; SD: Standard definition; WLE: White light endoscopy; NBI: Narrow band imaging; RCT: Randomized controlled trial; UC: Ulcerative colitis; CADe: Computer-aided detection; IBD: Inflammatory bowel disease.

Table 4 Studies comparing dye-based and virtual chromoendoscopy techniques for dysplasia detection in inflammatory bowel disease

Ref.	Techniques compared	Study design	Key findings
Bisschops et al[30], 2018	HD CE vs NBI	Multicenter RCT	No significant difference in dysplasia detection (21.2% vs 21.5%); NBI had shorter procedure time
Pellisé et al[31], 2011	HR CE vs HR NBI	Randomized crossover study	NBI is less time-consuming, but CE had a lower miss rate for intraepithelial neoplasia; not statistically significant
González-Bernardo et al[13], 2021	CE vs i-SCAN (VCE)	RCT	No significant difference in dysplasia detection rate; CE required more procedure time
Jans et al[32], 2024	CE vs i-SCAN OE	RCT	Both techniques are comparable in dysplasia detection; CE offered slightly better lesion characterization
Efthymiou et al[33], 2013	CE vs NBI	RCT	Dysplasia detection rates were similar; NBI had fewer false positives and was faster
Vleugels et al[34], 2018	CE vs AFI	RCT (FIND-UC trial)	CE had higher specificity and fewer false positives than AFI; no difference in dysplasia detection

CE: Chromoendoscopy; NBI: Narrow band imaging; VCE: Virtual chromoendoscopy; i-SCAN OE: I-SCAN optical enhancement; AFI: Autofluorescence imaging; HD: High definition; HR: High resolution; RCT: Randomized controlled trial; IBD: Inflammatory bowel disease.

Table 5 Comparative studies of multiple advanced endoscopic modalities for dysplasia detection in inflammatory bowel disease

Ref.	Techniques compared	Study design	Key findings
Hlavaty et al[35], 2011	SD WLE vs DCE vs CLE	Prospective cohort	Targeted biopsies are superior to random; DCE increased IEN detection; CLE did not add clinical benefit due to low evaluability of polypoid lesions
Iacucci et al[36], 2018	HD WLE vs HD DCE vs VCE (iSCAN)	Multicenter RCT	No significant difference in neoplasia detection; VCE had the best lesion visibility and was the most time-efficient
Gasia et al[3], 2016	HD WLE vs HD DCE vs HD CLE	Prospective observational	CLE combined with targeted biopsies provided the highest dysplasia detection rate, though more resource-intensive; random biopsies added little value

SD: Standard definition; HD: High definition; WLE: White light endoscopy; DCE: Dye-based chromoendoscopy; CLE: Confocal laser endomicroscopy; VCE: Virtual chromoendoscopy; IEN: Intraepithelial neoplasia; RCT: Randomized controlled trial; IBD: Inflammatory bowel disease.

Table 6 Comparative studies of targeted vs random biopsy strategies in inflammatory bowel disease dysplasia surveillance

Ref.	Biopsy protocol compared	Study design	Key findings
Mooiweer et al[20], 2015	Random biopsies (WLE) vs Targeted (DCE)	Retrospective multicenter	No significant difference in neoplasia detection (11% vs 10%, P = 0.80); questions the routine benefit of CE
Moussata et al[37], 2018	Targeted + Random biopsies (CE)	Prospective multicenter cohort	20% of neoplastic sites detected only by random biopsies; the highest yield in PSC, prior neoplasia, and tubular colon
Wan et al[23], 2021	Targeted (CE) vs Random (WLE) vs Targeted (WLE)	Multicenter RCT with long-term follow-up	CE with targeted biopsies was superior to WLE targeted (9.7% vs 1.9%, P = 0.004); random WLE was also better than WLE targeted alone
Carballal et al[2], 2018	Targeted (CE) vs Random (WLE)	Real-life prospective cohort	CE + targeted biopsies detected significantly more dysplasia than WLE with random biopsies
Gasia et al[3], 2016	Random vs Targeted (WLE, DCE, CLE)	Prospective observational	Random biopsies added minimal yield; targeted approach is more efficient
Günther et al[38], 2011	Targeted vs Random (WLE)	Retrospective analysis	Targeted biopsies are sufficient; random biopsies rarely add additional findings
Hlavaty et al[35], 2011	Targeted vs Random (CLE, DCE, WLE)	Prospective cohort	Targeted biopsies increased yield; CLE is not superior to DCE/WLE for flat lesions
Marion et al[19], 2008	Targeted (CE) vs Random (WLE)	Prospective single center	Targeted CE biopsies identified more dysplasia than random WLE biopsies
Leifeld et al[28], 2015	Targeted (NBI) vs Random (WLE)	RCT	No significant advantage of random biopsies in NBI-guided exams
Hu et al[39], 2021	Random vs Targeted (WLE, CE, VCE)	Retrospective cohort	Low diagnostic yield from random biopsies supports image-enhanced targeted approaches
Watanabe et al[40], 2011	Step biopsy vs Targeted biopsy	Japanese multicenter study	Target biopsy is non-inferior to step biopsy in neoplasia detection; fewer biopsies and reduced invasiveness

WLE: White light endoscopy; CE: Chromoendoscopy; DCE: Dye-based chromoendoscopy; VCE: Virtual chromoendoscopy; CLE: Confocal laser endomicroscopy; PSC: Primary sclerosing cholangitis; RCT: Randomized controlled trial; IBD: Inflammatory bowel disease.

Table 7 Endoscopic techniques for dysplasia characterization in inflammatory bowel disease

Ref.	Study design	Techniques compared	Key findings
Bisschops et al[30], 2018	Prospective comparative study	HD CE vs HD NBI	CE had higher sensitivity (88%) than NBI (60%) for Kudo pit pattern-based dysplasia diagnosis; NPV was similar (89%)
Carballal et al[2], 2018	Large prospective cohort study	WLE with targeted biopsies using the pit pattern	Non-polypoid morphology, proximal location, and type III-V pit pattern were associated with dysplasia; supports the pit pattern as a diagnostic adjunct
van den Broek et al[26], 2011	Prospective study	AFI, NBI, WLE	AFI had the highest sensitivity and NPV for dysplasia characterization; the combined use improved detection
Vleugels et al[34], 2018	Pre-specified analysis of FIND-UC RCT	Trimodal (AFI, NBI, WLE) vs CE	CE had slightly better sensitivity (82% vs 77%) for dysplasia; both had high NPV (> 94%); AFI alone had the best sensitivity (92%)

HD: High definition; CE: Chromoendoscopy; NBI: Narrow band imaging; WLE: White light endoscopy; AFI: Autofluorescence imaging; PDD: Photodynamic diagnosis; NPV: Negative predictive value; RCT: Randomized controlled trial; IBD: Inflammatory bowel disease.

Table 8 Practice pattern and quality of care in dysplasia surveillance

Ref.	Study type	Sample size	Key findings
Vienne et al[44], 2011	Survey (France, CESAME cohort)	583 patients	Only 54% of eligible IBD patients received surveillance colonoscopy; large inter-center variability (27%-70%) and low uptake in Crohn’s colitis. Chromoendoscopy was used in 30%, and random biopsies in 71%
Lewis et al[45], 2022	Survey of high-volume IBD providers (United States)	55 providers	Wide variation in practice: 20% regularly used DCE, 27% VCE, 58% random biopsies; random biopsy use is inversely related to DCE use; less than half believed random biopsies increased detection with HD-WLE
Te Groen M et al[46], 2024	Multicenter retrospective audit (Netherlands)	644 colonoscopies from 391 IBD patients	Major guideline deviations: Inadequate withdrawal time (52%), lack of inspection of prior dysplasia sites (68%), and suboptimal documentation; only 10.6% received surveillance consistent with guideline-defined high-quality colonoscopy

IBD: Inflammatory bowel disease; CESAME: Cohorte Epidémiologique Sur les Maladies de l’Appareil Digestif; DCE: Dye-based chromoendoscopy; VCE: Virtual chromoendoscopy; HD-WLE: High definition white light endoscopy.