Assessment of endoscopic healing by using advanced technologies reflects histological healing in ulcerative colitis.
Iacucci, Marietta Cannatelli, Rosanna Gui, Xianyong Zardo, Davide Bazarova, Alina Gkoutos, Georgios V Lethebe, Brendan Cord Kaplan, Gilaad G Panaccione, Remo Kiesslich, Ralf
Iacucci, Marietta
Cannatelli, Rosanna
Gui, Xianyong
Zardo, Davide
Bazarova, Alina
Gkoutos, Georgios V
Lethebe, Brendan Cord
Kaplan, Gilaad G
Panaccione, Remo
Kiesslich, Ralf
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2020-09-16
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Background: Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO [Paddington International Virtual ChromoendoScopy ScOre], Mayo Endoscopic Score [MES] and probe-based confocal laser endomicroscopy [pCLE] with histological indices in UC.
Methods: A prospective study enrolling 82 UC patients [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [HD-MES] and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver operating characteristic [ROC] curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index [RHI] and ECAP 'Extension, Chronicity, Activity, Plus' histology score.
Results: A modified PICaSSO of ≤ 4 predicted histological healing at RHI ≤ 3, with sensitivity, specificity, accuracy and area under the ROC curve [AUROC] of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7%, 85.4% and 92.1%, respectively. A pCLE ≤ 10 predicted histological healing with sensitivity of 94.9%, specificity of 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤ 10 was predicted by modified PICaSSO ≤ 4 with accuracy of 91.5% and AUROC of 95.9%.
Conclusion: Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic chromoendoscopy PICaSSO, endoscopic score; and the use of pCLE did not improve the accuracy any further.
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Iacucci M, Cannatelli R, Gui X, Zardo D, Bazarova A, Gkoutos GV, Lethebe BC, Kaplan GG, Panaccione R, Kiesslich R, Ghosh S. Assessment of Endoscopic Healing by Using Advanced Technologies Reflects Histological Healing in Ulcerative Colitis. J Crohns Colitis. 2020 Sep 16;14(9):1282-1289. doi: 10.1093/ecco-jcc/jjaa056
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