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International Session (Symposium)9 (JGES・JSGE・JSGS)
Sat. October 14th   14:40 - 17:00   Room 11: Fukuoka International Congress Center 502+503
IS-S9-Keynote Lecture2
Surveillance colonoscopy for ulcerative colitis "Up-to-date procedures and therapeutic strategies"
M. Iacucci1,2
1Institute of Translational Medicine, University of Birmingham, 2Division of Gastroenterology, University of Calgary
The SCENIC consensus proposed recommendations for optimal detection and management of dysplasia during colonoscopic surveillance for IBD. Although Dye Chromoendoscopy (DCE) with targeted biopsies is widely recognized as the standard of care and should be adopted to increase the detection of neoplastic lesions in daily practice, the endoscopic findings to characterize the colonic lesions still remains uncertain and debated in IBD. An endoscopic classification to predict histology and invasiveness of the IBD colonic lesions detected by dye chromoendoscopy before making a therapeutic decision of endoscopic resection vs surgical colectomy is currently not available.
Sugimoto et al recently described the morphology of High Grade Dysplasia (HGD) of IBD lesions following the SCENIC guidelines. In a retrospective study, they identified the endoscopic findings associated frequently with HGD such as flat/superficial elevated area and red discoloration and localization in the rectum and sigmoid colon. They concluded that magnification endoscopy may be more useful to distinguish the border of the lesion.
It is generally agreed that the value of Kudo pit pattern to predict histology remains controversial in IBD patients especially when these lesions are assessed by using standard scopes without magnification. The colonic mucosa of IBD patients might be distorted due to long standing chronic inflammation; furthermore dye spraying may also obscure Kudo pit pattern. However, it has been demonstrated that Kudo pit pattern can be assessed with the new generation HD with or without virtual chromoendoscopy and without magnification .
We have recently designed and validated a colonic lesions characterization - the FACILE IBD classification by international experts by a consensus followed by involvement of experienced gastroenterologists, gastroenterology trainees and endoscopy naïve junior doctors pre and post administration of a computerized training module. This demonstrated the operating characteristics of the FACILE IBD classification in a wide range of participants distinct from the original expert group who designed the classification system. Such lesion characterization may form the platform for a decision on feasibility of local endoscopic resection of dysplastic lesions during colonoscopic surveillance in IBD.

The optical diagnosis technologies can support the paradigm of real -time decision to biopsy, endoscopic resection or raise suspicion of concerning features.

These new techniques, combined with new endoscopic resection techniques may now be able to limit the number of colectomies that need to performed in the presence of dysplasia as improvement in performing local resection may spare panproctocolectomy. This has to be further studied in multicenter real life practice - future studies need real life multicenter experience of application of the FACILE IBD classification during colonoscopic surveillance as well as determine outcomes of colonoscopic endoscopic resection.
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