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Journal of Crohn's and Colitis: 10 (10)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Shomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKJesús Rivera-Nieves, USABritta Siegmund, GermanyGijs van den Brink, NLSéverine Vermeire, Belgium

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High-definition endoscopic imaging with i-Scan for the detection and characterization of duodenal Crohn's disease

Gheorghe Hundorfean, Abbas Agaimy, Mircea T. Chiriac, Markus F. Neurath, Jonas Mudter
DOI: http://dx.doi.org/10.1016/j.crohns.2012.08.008 e122-e123 First published online: 1 April 2013

Dear Sir,

Virtual (dye-less) chromoendoscopy with i-Scan (Pentax, Japan) is a sophisticated, advanced imaging technique within contemporary endoscopy which relies on a computer-based color program that enhances the contrast of mucosal details.1 In certain diagnostic settings, high-definition endoscopy with i-Scan has been proved superior to standard video endoscopy.2

Recent publications from our group regarding advanced endoscopic imaging techniques have addressed the utility of i-Scan for the diagnosis of gastric Crohn's disease3 as well as the applicability of confocal laser endomicroscopy for the detection of duodenal Crohn's disease4 and for endomicroscopic differentiation between Crohn's disease and ulcerative colitis.5 Still, data regarding the utility of virtual chromoendoscopy using i-Scan for the characterization and diagnosis of duodenal Crohn's disease have not been provided yet.

Here, we report the case of a 19-year-old female patient with a relapse of an ileocolic Crohn's disease, under an anti-TNFalpha therapy, who underwent a panendoscopic staging in our endoscopy unit.

High definition white-light esophagogastroduodenoscopy (Pentax EG-2990i, Japan) showed an edematous and slightly erythematous mucosa and irregular thickened folds in the duodenum (Fig. 1a). By switching to the i-Scan mode 2, we were able to detect Crohn's disease-typical small aphtoid erosions (Fig. 1b) on thickened duodenal folds. These features were not evident in the conventional high-definition white-light imaging (Fig. 1a). The gastric mucosa showed neither endoscopic, nor histologic signs of inflammation (not shown). Subsequent histopathological evaluation (haematoxylin-eosin stain) of conventional biopsies taken from the same duodenal area confirmed the diagnosis of a manifest Crohn's duodenitis. There was no evidence of cytomegalovirus infection, celiac or Whipple's disease.

Figure 1

High definition white-light endoscopy (a) revealed an edematous and slightly erythematous mucosa with irregular thickened folds in the duodenum. Virtual chromoendoscopy (i-Scan) highlighted reddish areas and Crohn's disease-typical aphtoid erosions (red arrowheads in b). Conventional hematoxylin-eosin stain (c) of a biopsy from the same area showed a prominent mixed inflammatory infiltrate with edema in the lamina propria together with evidence of crypt destruction.

In summary, based on these findings we could diagnose and characterize a duodenal manifestation of Crohn's disease by i-Scan, for the first time.

Here, we highlight the clinical usefulness of high-definition virtual chromoendoscopy using i-Scan for the characterization and diagnosis of duodenal Crohn's disease, which could contribute to a better diagnosis, treatment and outcome for Crohn's disease patients.

Conflict of interest

Nothing declared.

References

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