Can advanced endoscopic techniques for assessment of mucosal inflammation and healing approximate histology in inflammatory bowel disease?

Abstract

The targets of therapy in inflammatory bowel disease have transformed in the last few years. The standard definition of mucosal healing assessed using white light standard definition endoscopy is being challenged because even when endoscopy suggests mucosal healing, the presence of histological activity can often still be observed. Of note, microscopic signs of inflammation correlate with clinical outcomes such as risk of relapse, hospitalization and colorectal cancer. Therefore, histological healing has increasingly become an important target to achieve. Advanced endoscopic technologies have been developed and many are starting to be adopted in daily clinical practice. They can provide a more detailed view of the mucosal and vascular architecture almost at the histology level, including crypt, vessel architecture and cellular infiltration. So, these can provide a more accurate definition of mucosal and histological healing. In this review we focus on new advanced endoscopic techniques, and how these have the potential to reduce the gap between histological and mucosal healing.

Relationship Between Combined Histologic and Endoscopic Endpoints and Efficacy of Ustekinumab Treatment in Patients With Ulcerative Colitis

“…Studies are ongoing evaluating the use of advanced endoscopic techniques (ie, magnification endoscopy in combination with optical chromoendoscopy, i-scan optical enhancement, electronic virtual chromoendoscopy methods, confocal laser endomicroscopy [with or without probe], endocytoscopy) and their ability to provide near histology-level views of the mucosa and vascular architecture; these may mitigate the need for invasive biopsy sampling in the future for clinical trials as well as for clinical practice. 30 We conclude that an outcome of histo-endoscopic mucosal healing provides additional information regarding subsequent clinical status that endoscopy and histology alone do not. More research is needed to confirm the application of histologic improvement and histo-endoscopic mucosal healing to the prediction of remission in research and daily clinical practice.…”

Magnetic Resonance Enterography in the Diagnosis of Crohn’s Disease Using Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) Sequence. Doctoral Thesis

“…According to the ECCO-ESGAR consensus guidelines, the disease should be kept under control with mucosal healing (Panes J. et al, 2013). However, CD is a transmural inflammation that can persist despite healed mucosa (Castiglione et al, 2019a;Nardone et al, 2019). It is proven that, compared to mucosal healing, transmural healing is associated with improved long-term outcomes, including sustained long-term steroid-free clinical remission, reduced less need of rescue treatment, lower rates of CD-related hospitalisations and CD-related surgical treatment (Serban, 2018).…”

“…The endoscopic index of severity (CDEIS) and simplified endoscopic score of CD (SES-CD) are the scoring systems most commonly used for estimation of CD activity(Sturm et al, 2018). However, as endoscopy allows visualisation of only a limited part of the small intestine, assessing solely mucosa, its use in assessment of the full extent of the disease is limited(Zorzi et al, 2014;Civitelli et al, 2016;Nardone et al, 2019).…”

“…mucosal healing(Rimola et al, 2009;Moy et al, 2016;, CD is a transmural inflammation that can persist in patients with long-term mucosal healing(Zorzi et al, 2014;Civitelli et al, 2016;Nardone et al, 2019). It is proven that compared to mucosal healing, transmural healing is related to improved long-term outcomes, including sustained long-term steroid-free clinical remission, less need for rescue therapy, less CD-related hospitalisations and CD-related surgery(Serban, 2018).…”

Magnetic Resonance Enterography in the Diagnosis of Crohn’s Disease Using Diffusion-Weighted Imaging with Background Body Signal Suppression (DWIBS) Sequence. Summary of the Doctoral Thesis

“…Maaser et al, 2019;Moy, Sauk, and Gee, 2016;Rimola et al, 2009), CD is a transmural inflammation that can persist in patients with long-term mucosal healing(Civitelli et al, 2016;Nardone et al, 2019;Zorzi et al, 2014). It is proven that compared to mucosal healing, transmural healing is related to improved long-term outcomes, including sustained long-term steroid-free clinical remission, less need for rescue therapy, less CD-related hospitalisations and CDrelated surgery(Serban, 2018).…”