Clinical Endoscopy

Reviews

Advanced endoscopy and artificial intelligence-enabled vascular healing for ulcerative colitis: promising frontiers or mere mirage?: Yasuharu Maeda, Shin-ei Kudo, Takanori Kuroki, Yurie Kawabata, Jun Ohara, Katsuro Ichimasa, Noriyuki Ogata, Kazuo Ohtsuka, Masashi Misawa; Received June 11, 2025 Accepted August 12, 2025 Published online December 15, 2025; DOI: https://doi.org/10.5946/ce.2025.186 [Epub ahead of print]

Abstract PDF PubReader ePub: Ulcerative colitis, a chronic inflammatory bowel disease, is characterized by subtle microvascular alterations that play a critical role in disease perpetuation and mucosal injury. Recent advances in image-enhanced endoscopy and ultrahigh-magnification endoscopy have improved the real-time visualization of these vascular changes while highlighting their diagnostic value. Artificial intelligence (AI)-enabled endoscopic systems provide automated, reproducible vascular assessments. Emerging data suggest that AI-based vascular healing correlates with clinical remission and may alter histological scores, enabling the prediction of sustained remission. Despite these promising advances, challenges remain, such as standardizing vascular healing definitions, addressing interobserver variability, and validating AI-driven platforms in real-world settings. Integrating microvascular-targeted therapies and advanced imaging has the potential to transform the management of ulcerative colitis, facilitating sustained remission and improving the quality of life. This review examined the evolving role of microvascular assessment in ulcerative colitis, the potential of AI in refining endoscopic evaluation, and the prospects of incorporating vascular healing as a therapeutic target.

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Clinical significance of computer-aided quality assessment systems in colonoscopy: a comprehensive review: Wai Phyo Lwin, Katsuro Ichimasa, Shin-Ei Kudo, Yuta Kouyama, Taishi Okumura, Yasuharu Maeda, Yutaro Ide, Khay Guan Yeoh, Masashi Misawa; Clin Endosc 2025;58(5):638-645. Published online May 27, 2025; DOI: https://doi.org/10.5946/ce.2025.022

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Colonoscopy is the primary tool for colorectal cancer screening. High-quality colonoscopy is crucial for the detection of precancerous adenomas; however, the adenoma detection rate varies depending on the skill and experience of the endoscopist. Computer-aided quality assessment (CAQ) uses artificial intelligence (AI) technology to evaluate the quality of colonoscopy examinations. It plays an important role in reducing variations in examination quality and obtaining high-quality colonoscopic images. In this review, we focus specifically on the speedometer, effective withdrawal time, fold examination quality, bowel preparation quality assessment, and cecal intubation with CAQ systems and discuss the role and effectiveness of these systems. CAQ systems are expected to contribute to increase in adenoma detection rates, improvement in endoscopist skills, and standardization of examination quality. However, challenges such as variability in AI performance across different clinical settings and potential overreliance on automated prompts remain key limitations.

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Artificial Intelligence and Its Role in Endoscopic Adenoma and Cancer Detection
Hannah R. Phillips, Wilfor J. Diaz Fernandez, Cadman L. Leggett
Clinics in Colon and Rectal Surgery.2026;[Epub] CrossRef
Prospective Validation of the First US FDA-Approved Computer-Aided Quality Assessment Tool for Colonoscopy: An Initial Clinical Experience
Todd A. Brenner, Chris Labaki, Joseph D. Feuerstein, Tyler M. Berzin
American Journal of Gastroenterology.2025;[Epub] CrossRef

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Focused Review Series: Image-Enhanced Endoscopy: Update on Clinical Practice

Clinical Efficacy of Endocytoscopy for Gastrointestinal Endoscopy: Masashi Misawa, Shin-ei Kudo, Yuki Takashina, Yoshika Akimoto, Yasuharu Maeda, Yuichi Mori, Toyoki Kudo, Kunihiko Wakamura, Hideyuki Miyachi, Fumio Ishida, Haruhiro Inoue; Clin Endosc 2021;54(4):455-463. Published online July 7, 2021; DOI: https://doi.org/10.5946/ce.2021.165

Abstract PDF Supplementary Material PubReader ePub

Endocytoscopy (EC) is a contact-type optical endoscope that allows in vivo cellular observation during gastrointestinal endoscopy and is now commercially available not only in Japan but also in Asian, European Union, and Middle Eastern countries. EC helps conduct a highly accurate pathological prediction without biopsy. Initially, EC was reported to be effective for esophageal diseases. Subsequently, its efficacy for stomach and colorectal diseases has been reported. In this narrative review, we searched for clinical studies that investigated the efficacy of EC. EC seems to accurately diagnose gastrointestinal diseases without biopsy. Most of the studies aimed to clarify the relationship between endocytoscopic findings of gastrointestinal neoplasia and pathological diagnosis. Some studies have investigated non-epithelial lesions or diseases, such as inflammatory bowel disease or infectious diseases. However, there are few high-level pieces of evidence, such as randomized trials; thus, further studies are needed.

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Citations to this article as recorded by

White Light, Magnifying Endoscopy, Endocytoscopy, and Artificial Intelligence in Diagnosis of Early Colorectal Cancer: A Comparative Study
Eri Tamura, Shin‐ei Kudo, Shunto Iwasaki, Shigenori Semba, Tomoya Shibuya, Shun Kato, Takanori Kuroki, Yuta Sato, Tatsuya Sakurai, Yushi Ogawa, Yuta Kouyama, Yasuharu Maeda, Katsuro Ichimasa, Noriyuki Ogata, Takemasa Hayashi, Kunihiko Wakamura, Hideyuki M
DEN Open.2026;[Epub] CrossRef
Advanced Endoscopic Imaging for Assessing Mucosal Healing and Histologic Remission in Inflammatory Bowel Diseases
Tommaso Pessarelli, Gian Eugenio Tontini, Helmut Neumann
Gastrointestinal Endoscopy Clinics of North America.2025; 35(1): 159. CrossRef
Automated Endoscopic Diagnosis in IBD
Yasuharu Maeda, Shin-ei Kudo, Takanori Kuroki, Marietta Iacucci
Gastrointestinal Endoscopy Clinics of North America.2025; 35(1): 213. CrossRef
Texture and Color Enhancement Imaging-Assisted Endocytoscopy Improves Characterization of Gastric Precancerous Conditions: A Set of Interesting Comparative Images
Riccardo Vasapolli, Johannes Raphael Westphal, Christian Schulz
Diagnostics.2025; 15(15): 1925. CrossRef
Endocitoscopia de la muscular propia en acalasia de rápida evolución y recidiva de acalasia post-Heller
Hugo Uchima, Raquel Muñoz-González, Íngrid Marín, Noemí Caballero, Claudia Cepero, Ignacio Iborra, Juan Colán-Hernández, Edgar Castillo, Vicente Moreno
Gastroenterología y Hepatología.2024; 47(7): 761. CrossRef
Endocytoscopy of muscularis propria in rapidly evolving achalasia and recurrence of post-Heller achalasia
Hugo Uchima, Raquel Muñoz-González, Íngrid Marín, Noemí Caballero, Claudia Cepero, Ignacio Iborra, Juan Colán-Hernández, Edgar Castillo, Vicente Moreno
Gastroenterología y Hepatología (English Edition).2024; 47(7): 761. CrossRef
The diagnostic utility of endocytoscopy for the detection of gastric cancer: a systematic review and meta-analysis
Andrew CANAKIS, Shivanand BOMMAN, Benjamin TWERY, Nevin VARGHESE, Byung JI, Justin CANAKIS, Eric M. GOLDBERG
Minerva Gastroenterology.2024;[Epub] CrossRef
The diagnostic utility of endocytoscopy for the detection of esophageal lesions: A systematic review and meta-analysis
Lu Wang, Bofu Tang, Feifei Liu, Zhenyu Jiang, Xianmei Meng
Gastroenterology & Endoscopy.2023; 1(1): 12. CrossRef
A Review of Colonoscopy in Intestinal Diseases
Seung Hong, Dong Baek
Diagnostics.2023; 13(7): 1262. CrossRef
Endoscopic Imaging for the Diagnosis of Neoplastic and Pre-Neoplastic Conditions of the Stomach
Bruno Costa Martins, Renata Nobre Moura, Angelo So Taa Kum, Carolina Ogawa Matsubayashi, Sergio Barbosa Marques, Adriana Vaz Safatle-Ribeiro
Cancers.2023; 15(9): 2445. CrossRef
A comparative study of magnifying endoscopy with narrow-band image and endocytoscopy in the diagnosis of gastric neoplasm: a pilot study
In Kyung Yoo, Jun Chul Park, Hyuk Lee, Abdullah Ozgur Yeniova, Jeong Hoon Lee, Dong Keon Yon, Joo Young Cho, Wan-Sik Lee
European Journal of Gastroenterology & Hepatology.2023; 35(5): 530. CrossRef
Advances and challenges in gastrointestinal endoscopy: a comprehensive review
Sun Gyo Lim
Journal of Innovative Medical Technology.2023; 1(1): 10. CrossRef
The development and clinical application of microscopic endoscopy for in vivo optical biopsies: Endocytoscopy and confocal laser endomicroscopy
Huahui Zhang, Zhongyu He, Ziyi Jin, Qinglai Yan, Peng Wang, Xuesong Ye
Photodiagnosis and Photodynamic Therapy.2022; 38: 102826. CrossRef
Risk factors for early gastric cancer: focus on Helicobacter pylori gastritis
Hee Seok Moon
Journal of the Korean Medical Association.2022; 65(5): 259. CrossRef

9,086 View
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11 Web of Science
14 Crossref

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