From diagnosis to prognosis: artificial intelligence–driven endoscopy for precision care in inflammatory bowel disease

Identification and classification of dysplasia in patients with ulcerative colitis or Crohn's disease in the large intestine is a challenge. Surveillance programs in these patients aim to detect colitis-associated dysplasia at an early stage, as the risk of these patients developing colorectal cancer is considerable. Good communication and discussion between pathologists and endoscopists is essential to help reach unequivocal diagnoses and to improve the management of colitis-associated dysplasia. The risk of developing colorectal cancer in patients with colitis-associated dysplasia is considerable. Surveillance programs in patients with ulcerative colitis and Crohn's disease aim to detect dysplastic lesions early and rely heavily on taking random biopsy samples along the length of the colon. Diagnosing dysplasia can be difficult because of the heterogenous endoscopic appearance of dysplasia and the poor interobserver agreement among pathologists when grading dysplasia. Colitis-associated dysplasia may present as a dysplasia-associated lesion or mass (DALM), which may be indistinguishable from a sporadic adenoma in non-colitic tissue, or may arise in flat mucosa of endoscopically normal appearance. Information about the endoscopic appearance, the colonic distribution and the histopathological grade of colitis-associated dysplasia is required to define the optimal treatment. This Review summarizes the endoscopic and histopathological features of colitis-associated dysplasia and the requirements for optimal interaction between endoscopists and pathologists, with the aim of reducing the uncertainties in the diagnosis of dysplastic lesions and improving the management of colitis-associated dysplasia.