Pit patterns in rectal mucosa assessed by magnifying colonoscope are predictive of relapse in patients with quiescent ulcerative colitis

Abstract

Background: Relapse of ulcerative colitis is difficult to predict by routine colonoscopy. A high-resolution video-magnifying colonoscope with chromoscopy enables the observation of colorectal mucosal pit patterns. Aims: To investigate the association of pit patterns as assessed by magnifying colonoscopy (MCS) with histological inflammation and mucosal chemokine activity in patients with quiescent ulcerative colitis, and to prospectively analyse the prognostic factors that may predict exacerbations. Methods: MCS was performed in 113 patients with ulcerative colitis in remission. Pit patterns in the rectal mucosa were classified into four MCS grades on the basis of size, shape and arrangement. Mucosal interleukin (IL) 8 activity was measured in biopsy specimens of rectal mucosa and the specimens were assessed for histological disease activity. The patients were then followed until relapse or for a maximum of 12 months. Multivariate survival analysis was carried out to determine the independent predictors of clinical relapse. Results: A positive correlation was identified between MCS grade, histological grade (p = 0.001) and mucosal IL8 activity (p,0.001). Multivariate proportional hazard model analysis showed that MCS grade was a significant predictor of relapse (relative risk 2.06, p = 0.001). Kaplan-Meier estimate of relapse during 12 months of follow-up was found to increase with increasing MCS grade, with values of 0% for grade 1, 21% for grade 2, 43% for grade 3 and 60% for grade 4. Conclusion: MCS grading is associated with the degree of histological inflammation and mucosal IL8 activity in patients with quiescent ulcerative colitis, and may predict the probability of subsequent disease relapse in patients with ulcerative colitis in remission.

Magnifying colonoscopy used to predict disease relapse in patients with quiescent ulcerative colitis

“…[4][5][6] Other studies have reported the features of magnifying colonoscopy to be associated with the histological activity of UC and the prediction of disease relapse. 7,8 In the present study we investigated whether relapse of disease within 12 months could be predicted by precise observation of the surface colonic mucosa, especially by the findings of small defects, fine network, and crypt opening pattern on the surface epithelial mucosa by magnifying colonoscopy in patients with quiescent UC. Moreover, we compared the relationship between magnifying colonoscopic and histological findings.…”

Recent Advances of Endoscopy in Inflammatory Bowel Diseases

“…38 Moreover, Nishio et al investigated the association of pit patterns as assessed by magnifying endoscopy with histological inflammation and mucosal chemokine activity in patients with quiescent UC. 39 In that study, magnifying endoscopic grading was associated the degree of histological inflammation and mucosal interleukin-8 activity.…”

Magnifying chromoscopy, a novel and useful technique for colonoscopy in ulcerative colitis

“…Nishio et al [16] reported that magnifying-colonoscopy (MCS) grade was associated with the degree of histological inflammation and mucosal IL-8 activity in quiescent patients with ulcerative colitis, and might predict the probability of subsequent disease relapse in patients with ulcerative colitis in remission. Magnifying colonoscopy was performed in 113 patients in remission, and the relationship between pit patterns, IL-8 activity, and histological disease activity was evaluated.…”

“…Although MCS grade positively correlated with histological grade and mucosal IL-8 activity, these latter parameters were less accurate predictors of relapse. One reason may be that they are assessed in biopsy specimens derived from a specific and limited area of colorectal mucosa, whereas magnifying colonoscopy allows the observation of a more extended and representative area, and accordingly greater accuracy by MCS grading [16] . These findings demonstrate the usefulness of MCS in the evaluation of disease activity and in predicting relapse in patients with ulcerative colitis.…”

“…Even with this coverage, however, a set of 10 biopsy specimens has been theoretically calculated to represent only 0.05% of the total surface area of the whole colorectum [13] . Of interest, recent reports have indicated that careful mucosal examination aided by chromoendoscopy and magnifying endoscopy, and target biopsies of suspicious lesions might provide more effective surveillance than the taking of multiple non-targeted biopsies [14][15][16] .…”