Journal of Pathology and Translational Medicine

Review

Advances in the Endoscopic Assessment of Inflammatory Bowel Diseases: Cooperation between Endoscopic and Pathologic Evaluations: Jae Hee Cheon; J Pathol Transl Med. 2015;49(3):209-217. Published online May 15, 2015; DOI: https://doi.org/10.4132/jptm.2015.04.09

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Endoscopic assessment has a crucial role in the management of inflammatory bowel disease (IBD). It is particularly useful for the assessment of IBD disease extension, severity, and neoplasia surveillance. Recent advances in endoscopic imaging techniques have been revolutionized over the past decades, progressing from conventional white light endoscopy to novel endoscopic techniques using molecular probes or electronic filter technologies. These new technologies allow for visualization of the mucosa in detail and monitor for inflammation/dysplasia at the cellular or sub-cellular level. These techniques may enable us to alter the IBD surveillance paradigm from four quadrant random biopsy to targeted biopsy and diagnosis. High definition endoscopy and dye-based chromoendoscopy can improve the detection rate of dysplasia and evaluate inflammatory changes with better visualization. Dye-less chromoendoscopy, including narrow band imaging, iScan, and autofluorescence imaging can also enhance surveillance in comparison to white light endoscopy with optical or electronic filter technologies. Moreover, confocal laser endomicroscopy or endocytoscopy have can achieve real-time histology evaluation in vivo and have greater accuracy in comparison with histology. These new technologies could be combined with standard endoscopy or further histologic confirmation in patients with IBD. This review offers an evidence-based overview of new endoscopic techniques in patients with IBD.

Citations

Citations to this article as recorded by

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Photodiagnosis and Photodynamic Therapy.2024; 48: 104220. CrossRef
Colorectal cancer in inflammatory bowel disease: review of the evidence
D. S. Keller, A. Windsor, R. Cohen, M. Chand
Techniques in Coloproctology.2019; 23(1): 3. CrossRef
Probe-based confocal laser endomicroscopy in the differential diagnosis of inflammatory bowel diseases: a case series
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Intestinal Research.2018; 16(4): 641. CrossRef
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World Journal of Gastroenterology.2016; 22(46): 10198. CrossRef

Case Report

Endoscopic Ultrasound-Guided Fine Needle Aspiration Cytology in the Diagnosis of a Gastrointestinal Stromal Tumor of the Stomach: A Case Report.: Lucia Kim, Hyung Gil Kim, Young Chae Chu, In Suh Park, Suk Jin Choi, Jee Young Han, Sun Hee Kim, Don Haeng Lee, Joon Mee Kim; Korean J Cytopathol. 2008;19(2):178-182.; DOI: https://doi.org/10.3338/kjc.2008.19.2.178

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Abstract PDF: We report here a case of a gastrointestinal stromal tumor (GIST) in the stomach that was diagnosed by endoscopic ultrasound-guided fine needle aspiration cytology (EUS-FNA). A 67 year old male patient underwent regular check-ups for five years due to the presence of a submucosal tumor that was found in the fundus of the stomach incidentally. EUS-FNA was performed to evaluate the tumor, which had increased in size from 1cm to 2.8cm. A cytologic smear revealed cohesive sheets or clusters of spindle cells with elongated nuclei. Immunohistochemical staining revealed a strong positive reaction for c-kit and CD34, without any reaction for smooth muscle actin and Ki-67. Therefore, a diagnosis of GIST was made.

Original Articles

Clinicopathologic Characteristics of Ulcerative Colitis Diagnosed by Endoscopic Biopsy Specimen: An analysis of discrepancy between clinical and pathologic diagnosis.: Jong Yup Bae, Ho Guen Kim; Korean J Pathol. 1996;30(12):1091-1098.

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Abstract PDF: Chronic ulcerative colitis is a systemic inflammatory disease with uncertain etiology primarily involving the colonic mucosa. The mucosal biopsy interpretation is important for an evaluation of the disease state and further medical or surgical treatment. However, few clinical and pathological studies of the endoscopic diagnosis of this disease are available in Korea. Therefore, we evaluated the clinical and pathological characteristics of it diagnosed by endoscopic biopsy and analysed the reasons for the discrepancy between clinical and pathologic diagnosis for a more accurate endoscopic mucosal biopsy diagnosis in the future. A total of 702 cases of colonic mucosal biopsy specimens during Feb. 1994 and Jan. 1995 at Severance hospital, Yonsei University College of Medicine were reevaluated for the study. A clinical diagnosis of ulcerative colitis, after endoscopic examination, was made in 61(8.7%) cases. A pathological diagnosis was made when there is an increased inflammatory cell infiltration in the mucosa with evidences of a chronic crypt injury in the biopsy specimens. Using this criteria, a diagnosis was made in 32(52.3%) cases. In 29 cases the diagnosis was made in the first biopsy specimen and in the remaining 3 cases the diagnosis was made in the second or third biopsy specimens. No pathologic diagnosis of ulcerative colitis was made in the cases that clinical diagnosis was not. In the 32 cases diagnosed as ulcerative colitis, 14 cases were involved the rectum and sigmoid colon, 9 cases were involved up to the descending colon, 1 case was involved up to the transverse colon and 8 cases showed pancolonic involvement. In 29 cases, which ulcerative colitis was suspected clinically but was not consistent with it pathologically, 8 cases were proved to be ischemic colitis, 5 cases were acute infectious colitis and one case was Crohn's disease by repeat examination and follow up. Ten cases were histologically within normal range and lesions subsided spontaneously with no recurrence. A conclusive diagnosis could not be made in 5 cases during this study period. From these results, we conclude that ulcerative colitis can be diagnosed accurately by endoscopic biopsy, and clinical follow up and repeat examination are valuable in the differential diagnosis of this disease.

Antibiotics-associated Pseudomembranous Colitis: A Clinico-Pathologic Analysis with Special Reference to Non-pseudomembranous Mucosal Change.: Jin Haeng Chung, Yong Il Kim; Korean J Pathol. 1997;31(4):308-313.

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Abstract PDF: The presence of volcano-shaped pseudomembrane(PM) formations above the inflamed mucosa has been referred to as the unique biopsy criterion of the pseudomembranous colitis, but PM might be lost during the bowel preparation, and such loss leads pathologists to erroneous interpretations of the endoscopic biopsy specimens. The purpose of this paper is to identify the additional diagnostic clue other than PM among various histologic features in pseudomembranous colitis. We reviewed sigmoidoscopic biopsy specimens from 13 cases of antibiotics-associated pseudomembranous colitis which was confirmed to reveal characteristic PM by endoscopy aside from the clinical history of antibiotics administration. The cases were divided into two groups: the presence of PM (n=7) and its absence (n=6). Both groups showed basically identical histology, which included features of glandular distension, epithelial necrosis, crypt abscess, regenerative glands and mucous plug within the necrotic/dilated glands. Mucous plugs within the necrotic/ dilated glands were found in all cases and seemed to be the most characteristic microscopic feature. Ten cases of resected chronic ulcerative colitis in the active stage were compared for a differential diagnosis of crypt abscess-associated mucosal change. None of them revealed necrotic gland with mucous plugs, although crypt abscess formation was common in both conditions. We conclude that presence of mucous plugs in the dilated/necrotic glands is a useful diagnostic clue even though the biopsy specimens fail to demonstrate PM.

Pseudolipomatosis of the Gastrointestinal Mucosa: Report of 6 cases with analysis of possible factors involved during endoscopic procedure.: Ghee Young Choe, Yong Il Kim, Kyoo Wan Choi, Kee Suk Hong; Korean J Pathol. 1992;26(1):10-16.

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Abstract PDF: Pseudolipomatosis of the colonic mucosa has been recognized as a lesion featured with aggregations of gaseous spaces in the lamina propria, but its pathogenesis remains still unclear. This paper describes 6 cases of pseudolipomatosis occurring in the mucosa of stomach and large intestine, and the possible factors involved in gastrointestinal endoscopic procedure to produce gaseous entrapment in the lamina propria were analysed. All cases received either gastroscopy or colonoscpy before endoscopic biopsy. Mucosal tissues from both stomach and recto-sigmoid colon revealed multiple aggregations of small air-spaces resembling fatty infiltration in the lamina propria. Rarely were similar infiltrations within the muscularis mucosae and adjacent lymphoid follicles. Evidence for pneumatosis cystoides intestinalis or ulcerative colonic lesion was not associated, although one showed a small gastric ulcer nearby. Repeated inflations and deflations of the stomach or colon during the endoscopic procedure with miner mechanical trauma by instrument to the mucosa seem to contribute to its pathogenesis.

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