Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Update 2019.

1:  ESGE suggests that high definition endoscopy, and dye or virtual chromoendoscopy, as well as add-on devices, can be used in average risk patients to increase the endoscopist's adenoma detection rate. However, their routine use must be balanced against costs and practical considerations.Weak recommendation, high quality evidence. 2:  ESGE recommends the routine use of high definition systems in individuals with Lynch syndrome.Strong recommendation, high quality evidence. 3:  ESGE recommends the routine use, with targeted biopsies, of dye-based pancolonic chromoendoscopy or virtual chromoendoscopy for neoplasia surveillance in patients with long-standing colitis.Strong recommendation, moderate quality evidence. 4:  ESGE suggests that virtual chromoendoscopy and dye-based chromoendoscopy can be used, under strictly controlled conditions, for real-time optical diagnosis of diminutive (≤ 5 mm) colorectal polyps and can replace histopathological diagnosis. The optical diagnosis has to be reported using validated scales, must be adequately photodocumented, and can be performed only by experienced endoscopists who are adequately trained, as defined in the ESGE curriculum, and audited.Weak recommendation, high quality evidence. 5:  ESGE recommends the use of high definition white-light endoscopy in combination with (virtual) chromoendoscopy to predict the presence and depth of any submucosal invasion in nonpedunculated colorectal polyps prior to any treatment. Strong recommendation, moderate quality evidence. 6:  ESGE recommends the use of virtual or dye-based chromoendoscopy in addition to white-light endoscopy for the detection of residual neoplasia at a piecemeal polypectomy scar site. Strong recommendation, moderate quality evidence. 7:  ESGE suggests the possible incorporation of computer-aided diagnosis (detection and characterization of lesions) to colonoscopy, if acceptable and reproducible accuracy for colorectal neoplasia is demonstrated in high quality multicenter in vivo clinical studies. Possible significant risks with implementation, specifically endoscopist deskilling and over-reliance on artificial intelligence, unrepresentative training datasets, and hacking, need to be considered. Weak recommendation, low quality evidence.

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R. Bisschops has provided consultancy to and received research grants and speaker’s fees from Pentax (2008 to present) and Fujifilm (2015 to present); his department has received research grants and equipment from Pentax and Fujifilm (2015 to present). E. Coron received speaker’s fees or congress invitations from Fujifilm (2016 – 2019), and speaker’s fees from Olympus (2016, 2017). J. East received a speaker’s fee from Falk (January 2018); he has served on a Clinical Advisory Board of Boston Scientific (March 2018 to March 2019). C. Hassan has received research support from Fujifilm (2017 to present); his department has received support from Sonoscape. J. E. van Hooft has received lecture fees from Medtronics (2014 – 2015) and Cook Medical (2019), and consultancy fees from Boston Scientific (2014 – 2017); her department has received research grants from Cook Medical (2014 – 2018) and Abbott (2014 – 2017). M. Iacucci has received a research grant and consultancy fee from Pentax (2013 – 2019), and a research grant from Fujifilm (2018 – 2019); her department has received a research grant from Olympus (2017 – 2019). M.F. Kaminski has received speaker’s, teaching, and consultancy fees from Olympus (2017 to present) and speaker’s and teaching fees, and a loan of equipment from Fujifilm (2019). H. Neumann has provided consultancy to Fujifilm, Pentax, Motus GI, Boston Scientific, and Cook (2012 to present). M. Pellisé has received speaker’s fees from Casen Recordati (2016 – 2019), Olympus (2018), and Jansen (2018), consultancy and speaker’s fees from Norgine Iberia (2015 – 2019), a consultancy fee from GI Apply (2019), and research funding from Fujifilm Spain (2019); her department has received material on loan from Fujifilm Spain (2017 to present) and research grants from Olympus Europe (2005 to present); she is a board member of ESGE and SEED (2016 to present). I. Puig’s department has received loans of equipment to conduct a study from Olympus Europe (2019 – 2021) and Fujifilm Europe (January 2019 – December 2019). Y. Mori has provided consultancy to and received a Speaker’s honorarium from Olympus (2017 – 2019). G. Antonelli, M. Bustamente Balén, G. Cortas, E. Dekker, Y. Hazewinkel, G. Longcroft-Wheaton, and N. Pilonis have no competing interests.