Beyond complete endoscopic healing: Goblet appearance using an endocytoscope to predict future sustained clinical remission in ulcerative colitis

Abstract

Objectives Complete endoscopic healing, defined as Mayo endoscopic score (MES) = 0, is an optimal target in the treatment of ulcerative colitis (UC). However, some patients with MES = 0 show clinical relapse within 12 months. Histologic goblet mucin depletion has emerged as a predictor of clinical relapse in patients with MES = 0. We observed goblet depletion in vivo using an endocytoscope, and analyzed the association between goblet appearance and future prognosis in UC patients. Methods In this retrospective cohort study, all enrolled UC patients had MES = 0 and confirmed clinical remission between October 2016 and March 2020. We classified the patients into two groups according to the goblet appearance status: preserved‐goblet and depleted‐goblet groups. We followed the patients until March 2021 and evaluated the difference in cumulative clinical relapse rates between the two groups. Results We identified 125 patients with MES = 0 as the study subjects. Five patients were subsequently excluded. Thus, we analyzed the data for 120 patients, of whom 39 were classified as the preserved‐goblet group and 81 as the depleted‐goblet group. The patients were followed‐up for a median of 549 days. During follow‐up, the depleted‐goblet group had a significantly higher cumulative clinical relapse rate than the preserved‐goblet group (19% [15/81] vs. 5% [2/39], respectively; P = 0.02). Conclusions Observing goblet appearance in vivo allowed us to better predict the future prognosis of UC patients with MES = 0. This approach may assist clinicians with onsite decision‐making regarding treatment interventions without a biopsy.

Technological advances in inflammatory bowel disease endoscopy and histology

“…In another study of UC subjects in ER (MES 0), EC reliably differentiates those in HR from those with histologically active disease (28). Similarly, Takishima et al (29) observed that number of Goblet cells quantified with EC predicted long-term sustained clinical remission in UC patients in ER (MES 0). Moreover, a recent study by Vitali et al (30) showed endocytoscopic assessment of microscopic disease activity in UC was more accurate than WL endoscopy and highly correlated with histological scores; furthermore, EC was shown as reliable as histology for prediction of clinical outcomes in UC patients.…”

Evolution and New Horizons of Endoscopy in Inflammatory Bowel Diseases

“…A preliminary study confirmed that endocytoscopic evaluation of UC activity, graded with a dedicated score (ECS), had a stronger correlation with histology compared to normal endoscopic scores such as MES or UCEIS [70]. Another pivotal study showed how endocytoscopy could predict disease outcome by assessing the depletion of goblet cells [71]. Goblet cells are known to decrease in the presence of inflammation, but thus far, their assessment was only possible with conventional microscopy or CLE.…”

“…Goblet cells are known to decrease in the presence of inflammation, but thus far, their assessment was only possible with conventional microscopy or CLE. In particular, the authors used the number of Goblet cells seen at endocytoscopy to stratify the risk of relapse in a large population of UC patients in endoscopic remission (MES 0) [71].…”

A Review of Colonoscopy in Intestinal Diseases

“…Ueda et al classified EC appearance into four categories, EC-A, EC-B, EC-C, and EC-D, and showed correlations with MES, clinical activity, and pathological microscopic features of UC [ 197 ]. Kazumi et al evaluated goblet cells in 120 patients with an MES of 0 using endocytoscopy, and found that depleted goblet cells had a higher clinical relapse rate than non-depleted goblet cells ( p = 0.02) [ 198 ]. Maeda et al evaluated 52 patients with UC by endocytoscopy NBI, and the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of EC-NBI in diagnosing acute inflammation were 84.0%, 100%, 87.1%, 100% and 92.3%, respectively.…”