Endocytoscopic classification can be predictive for relapse in ulcerative colitis

Abstract

The present study was conducted to explore the association of endocytoscopy (EC) classification with microscopic inflammatory features of ulcerative colitis (UC) and disease relapse.EC was performed for mild-to-moderate UC 32 cases from January 2010 to August 2016. EC appearance was stratified into 4 categories: EC-A, regular arrangement of round to oval pits; EC-B, irregular arrangement with/without enlarged spaces between regular pits; EC-C, deformed pits with distorted crypt lumen which are unordered in arrangement but not disrupted; and EC-D, disruptive or disappeared pits. We evaluated the association of EC classification with Mayo endoscopic subscores (MES) and the clinically active state. Microscopic features including the severity in mucosal inflammatory infiltrates the presence of crypt abscess and goblet cell depletion were assessed by an experienced pathologist who was blinded to clinical and endoscopic information. Clinical follow-up was provided for treating 22 UC patients more than 60 months after EC.There were 15 cases in EC-A, 8 in EC-B, 5 in EC-C, and 4 in EC-D. Interobserver agreement was excellent with κ value of 0.77. There were 13 patients in active disease stage, while 19 in remission. Each EC-A case was in clinically remission stage, while all the EC-C and EC-D cases were in the active stage. There were 4 and 4 EC-B cases in remission and active stage, respectively. The EC-A group consisted of 11 MES0 and 4 MES1 cases, whereas the EC-B group consisted of 2 MES0 and 6 MES1 cases. There were no cases of MES0 in the EC-C and -D groups. The EC stratification was significantly associated with pathognomonic microscopic features for UC. There were significant differences in the remission rate among the EC groups. None had relapse in the EC-A group during the follow-up period.EC stratification could be predictive for relapse in UC. Moreover, EC is reliable to assess UC specific microscopic features.

Endocytoscopic intramucosal capillary network changes and crypt architecture abnormalities can predict relapse in patients with an ulcerative colitis Mayo endoscopic score of 1

“…Previous reports using advanced endoscopic technologies confirmed the efficacy of evaluating microvessels and glandular cavities to predict histological severity and clinical relapse 9‐12,17–23 . In the present study, we found that patients with an MES of 1 in clinical remission with intramucosal capillary network changes and crypt architecture abnormalities were at a high risk of experiencing clinical relapse as well as the presence of histological inflammation 24,25 .…”

“…Nishiyama et al 34 and Ueda et al 11 reported that EC staining can predict clinical relapse. However, these results could not be generalized in previous studies because of limited patient numbers (<30 patients) and observation area (rectum only).…”

“…Endocytoscopy ([EC] × 520 ultramagnifying colonoscope; Olympus Corp., Tokyo, Japan) combined with narrow‐band imaging (NBI; EC‐NBI) allows in vivo visualization of intramucosal capillary network patterns and crypt architecture 6–8 . Intramucosal capillary networks and crypt architecture have a strong correlation with histological findings 9–11 . In the present study, we demonstrated the impact of intramucosal capillary network changes and crypt architecture abnormalities to subclassify patients with an MES of 1 into a low‐ or high‐risk group for clinical relapse (Fig.…”

Unmet Medical Needs in the Management of Ulcerative Colitis: Results of an Italian Delphi Consensus

“…In fact, in UC, mucosal healing has been associated with fewer major surgeries and fewer hospitalisations [17]. Notwithstanding, newer endoscopic techniques have highlighted the possibility that even among patients with normalised endoscopic features, a proportion of tissue with residual microscopic activity is relevant for subsequent relapses [18–21]. Furthermore, long-lasting action is an aspect that is considered by patients to be very important, and it is one of the most frequently cited items when considering patient preferences for treatment [3, 4].…”

Endoscopic imaging in inflammatory bowel disease: current developments and emerging strategies

“…Furthermore, a recently developed CAD system has enabled the fully automatic identification of persistent histologic inflammation on EC images associated with UC [76]. Subsequent research has demonstrated that endocytoscopic stratification can be predictive for relapse in patients with mildly to moderately active UC [77]. In case of reports, EC was successfully used for adenoma identification during the surveillance of an IBD patient [78,79].…”