Future of endoscopy and IBD

Advanced endoscopic imaging has the potential to bridge the gap between endoscopy and the precision and predictive power of pathology and molecular medicine. Practical advances in endoscopy include the real ability to move beyond low-yield random biopsy to image-guided targeted biopsy. Advanced imaging now allows endoscopic removal of discrete adenomatous lesions, reserving surgery for DALM lesions with unclear borders. Clinical trials and practice is increasingly using mucosal healing to determine therapeutic response. This will extend to advanced imaging to assess mucosal healing at an endoscopic, histologic, and molecular level. Molecular imaging now allows direction endoscopic assessment of drug binding, which will allow selection of specific monoclonal antibody and other targeted therapy. By directly assessing drug binding in vivo, these technologies will speed drug development and provide more precise short-term outcomes.