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.

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

1
Kodashima
S.
Fujishiro
M.
Novel image-enhanced endoscopy with i-scan technology
World J Gastroenterol
 
16
9
Mar 7 2010
1043
2
Hoffman
A.
Sar
F.
Goetz
M.
Tresch
A.
Mudter
J.
Biesterfeld
S.
et al
High definition colonoscopy combined with i-Scan is superior in the detection of colorectal neoplasias compared with standard video colonoscopy: a prospective randomized controlled trial
Endoscopy
 
42
10
Oct 2010
827
833
[Epub 2010 Aug 27]
3
Hundorfean
G.
Agaimy
A.
Hartmann
A.
Chiriac
M.T.
Siebler
J.
Neurath
M.F.
et al
In vivo diagnosis and characterization of gastric Crohn's disease using endomicroscopy and virtual chromoendoscopy
Endoscopy
 
44
Suppl. 2
Jun 2012
E263
E264
[Epub 2012 Jul 13]
4
Hundorfean
G.
Agaimy
A.
Atreya
R.
Mudter
J.
Neurath
M.F.
Neumann
H.
Confocal laser endomicroscopy for characterization of Crohn's disease-associated duodenitis
Endoscopy
 
44
Suppl. 2
Apr 2012
[UCTN:E80. Epub 2012 Mar 6]
5
Hundorfean
G.
Chiriac
M.T.
Mudter
J.
Neurath
M.F.
Confocal laser endomicroscopy provides potential differentiation criteria between Crohn's disease and ulcerative colitis
Inflamm Bowel Dis
 
Jun 8 2012
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.

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.