Beyond conventional endoscopy: Image-enhanced techniques in quiescent ulcerative colitis assessment

Mucosal healing is an important therapeutic target in ulcerative colitis (UC) because it is associated with improved clinical outcomes and sustained remission. Conventional white-light endoscopy has limitations, including subjective interpretation, interobserver variability, and difficulty detecting residual microscopic inflammation despite an apparently healed mucosa. Image-enhanced endoscopy (IEE) techniques improve visualization of mucosal and vascular patterns, potentially enhancing the assessment of inflammation and healing in UC. Modalities such as narrow-band imaging, linked-color imaging, blue laser imaging, dual-red imaging, texture and color enhancement imaging, and iSCAN accentuate vascular structures and subtle color differences, allowing more precise differentiation between complete and partial healing. These methods correlate strongly with histological inflammation and better predict clinical relapse compared with conventional scoring systems such as the Mayo Endoscopic Subscore. Quantitative IEE-based indices, including the linked-color imaging index, Paddington International virtual ChromoendoScopy ScOre, and Mucosal Analysis of Inflammatory Gravity by iScan TE-c Image score, provide reproducible and objective measurements that reduce subjective variability. Next-generation endoscopic platforms combining advanced IEE technologies enable real-time, high-resolution evaluation of mucosal microarchitecture and vascular regeneration. This facilitates personalized management by detecting residual inflammation earlier, improving monitoring, optimizing treatment decisions, and ultimately enhancing long-term outcomes while lowering relapse rates in UC patients.