Novel approaches in colorectal endoscopy: what do we need biopsies for?

Magnification chromoendoscopy, narrow band imaging (NBI) and confocal endomicroscopy can all provide accurate assessment of small and diminutive colonic lesions for neoplastic change that approaches the accuracy of standard histopathology. It is likely that there will be a move to use these techniques in clinical practice for small and particularly diminutive, non-depressed lesions in the near future. Non-neoplastic lesions would be left in situ, and neoplastic lesions resected and disposed of without histopathological assessment. Histopathology would be reserved for larger lesions, indeterminate lesions or lesions where invasion was suspected. There are potentially significant cost savings and patient benefits, with a focussing of histopathological expertise on higher risk lesions, particularly in the era of bowel cancer screening. These techniques may also help target biopsies in colitis surveillance, removing the need for large numbers of random samples. However, in order to convince patients, histopathologists and those funding healthcare of the validity of this approach, further trial data will be needed, with an accreditation process for endoscopists wishing to take on this responsibility.