15 The authors’ experience and others’, however, suggest that the current pit pattern classification may not be completely applicable in UC, because the pit pattern of the regenerative hyperplastic villous mucosa in UC (with the pits becoming elongated and irregular, Target Selective Inhibitor high throughput screening depending on the degree of inflammation) is difficult to distinguish from neoplastic pit patterns. Instead of using the current pit pattern classification,48

the authors have previously reported that high residual density of pits and irregular pit margins with magnification after indigo carmine dye spraying were useful to differentiate between colitis-associated neoplastic and non-neoplastic lesions.33 Therefore, in the authors’ practice, they focus on CHIR-99021 solubility dmso the high residual density of pits and irregular pit margins observed under magnifying chromocolonoscopy.33 The main pit patterns of neoplasia in cIBD have been reported as type IV and type IIIS with a IIIL pit pattern. Sada and colleagues16 described that magnifying colonoscopy of 15 neoplasias

and showed that the patterns being type IIIS- to IIIL or type IV pit. Hata and colleagues30 reported that they found no neoplastic lesions in regions characterized by type II or I pit patterns. However, they also noted that some non-neoplastic flat lesions also have type III and IV pit patterns, which are neoplastic patterns. After completion of the characterization of the lesion, the authors perform the biopsy or remove the lesion. NBI is commonly used for the management of colorectal lesions in Japan. A large

body of the literature has reported on the utility of NBI for the detection of colorectal polyps49, 50, 51, 52, 53 and 54 and for differentiating the diagnosis between neoplastic and non-neoplastic lesions.49, 55, 56, 57, 58, 59, 60 and 61 Conversely, some studies have suggested that NBI magnification is not effective for the detection of colorectal neoplasia.62, 63, 64, 65 and 66 An advantage of NBI magnification is that it can be achieved without spraying dye, thus potentially reducing the cost. Because NBI Nabilone involves a simple one-touch operation, NBI magnification may shorten the procedure time required for diagnosing NP-CRN in IBD and make the surveillance colonoscopy efficient. The major limitation of NBI, however, is that the visual field becomes too dark during its application. A newer generation of NBI has, therefore, been developed with improved brightness, although prospective trials have not been performed. In the previous clinical research on the significance of NBI endoscopy in detecting NP-CRN in patients with UC, surveillance colonoscopy using NBI was associated with negative results34, 35, 36 and 37; no significant difference in the ability to detect NP-CRN was found between NBI and white light endoscopy (Table 2).