Advanced endoscopic imaging for the detection and characterization of lesions of the colon: ESGE guidelines

Over the past 15 years many new endoscopic techniques and technologies have been developed that have revolutionized the management of colorectal lesions. The progressive increase in the identification rate of neoplastic lesions of the colon, combined with the possibility of characterizing the lesions to accurately allocate the appropriate treatment, without the need for biopsy and histological examination, have substantially contributed to the reduction of colorectal cancer incidence and mortality. They have also launched endoscopy into a new era. For all these techniques, the potential benefit has to be balanced against the possible financial burden, learning curve, and additional costs. In general, even in the setting of a fully randomised trial, there is a potential bias in the available literature given that it is impossible to blind the endoscopist to the technique that is being studied, and therefore there is always a potential bias in favour of any technique that may affect the performance of the endoscopists, even subconsciously. In this article, we focused our attention on the latest ESGE guidelines, particularly the recommendations and the degree of evidence of the most significant statements on the use of advanced endoscopic imaging for the detection and characterisation of colorectal neoplasia. Furthermore, as these guidelines are the first to address Artificial Intelligence (AI) in endoscopy, we have included a small focus on this in the AI section.