To reduce patients’ burden and increase the diagnostic accuracy and quality, conventional white-light endoscopy is still evolving and improving. The combination of high-definition TV image quality and high angle of view supports detailed observation and facilitates detection of lesions. Diameter of endoscopy may be critical to reduce patients’ burden. Endoscopy with a relatively small diameter (e.g., Olympus PCF-PQ260, diameter 9.2 mm) is useful not only to reduce patients’ pains but also to be able to pass through mild to moderate strictures in the anal area (Fig. 9.3) and anastomotic strictured site (Fig. 9.4). Endoscopy with a relatively small diameter is sometimes difficult to insert into the proximal colon and the ileum. However, the characteristics of new responsive insertion technology with passive bending and high force transmission are easier on both patients and physicians despite the smaller diameter.

Clinical usefulness of image-enhanced endoscopy in inflammatory bowel disease in terms of determining disease severity and extent and detecting dysplasia is shown in Table 9.1. NBI has been developed to increase diagnostic accuracy of gastrointestinal adenoma/cancer by improving visual definition of the mucosal surface and by enhancing mucosal vessels. NBI enables not only to detect colon polyps easier but also to assess the possibility of endoscopic resection. Therefore, NBI is now being studied to detect colitis-associated dysplasia. Moreover, because NBI emphasizes mucosal microvessel, it is easier to detect small erosions and aphthae especially in patients with CD (Figs. 9.5 and 9.6). Indigo carmine dye is also useful to detect aphthae in the small intestinal lesions of CD (Fig. 9.6b). However, NBI may be less time-consuming and equally effective to chromoendoscopy for the detection of aphthae (Fig. 9.6c).