Beyond white light: optical enhancement in conjunction with magnification colonoscopy for the assessment of mucosal healing in ulcerative colitis

Abstract

Background and study aim The I-SCAN optical enhancement (OE) system with magnification is a recently introduced combination of optical and digital electronic virtual chromoendoscopy, which enhances mucosal and vascular details. The aim of this pilot study was to investigate the use of I-SCAN OE in the assessment of inflammatory changes in ulcerative colitis (UC).

Patients and methods A total of 41 consecutive patients with UC and 9 control patients were examined by I-SCAN OE (Pentax Medical, Tokyo, Japan). Targeted biopsies of the imaged areas were obtained. A new optical enhancement score focusing on mucosal and vascular changes was developed. The diagnostic accuracy of I-SCAN OE was calculated against histology using two UC histological scores – Robarts Histopathology Index (RHI) and ECAP (Extent, Chronicity, Activity, Plus additional findings).

Results The overall I-SCAN OE score correlated with ECAP (r = 0.70; P < 0.001). The accuracy of the overall I-SCAN OE score to detect abnormalities by ECAP was 80 % (sensitivity 78 %, specificity 100 %). I-SCAN OE vascular and mucosal scores correlated with ECAP (r = 0.65 and 0.71, respectively; P < 0.001). The correlation between overall I-SCAN OE score and RHI was r = 0.61 (P < 0.01), and the accuracy to detect abnormalities by RHI was 68 % (sensitivity 78 %, specificity 50 %). The majority of patients with Mayo 0 had abnormalities on I-SCAN OE.

Conclusion In UC, the new I-SCAN OE technology accurately identified mucosal inflammation, and correlated well with histological scores of chronic and acute changes.

• References

• 1 Travis SP. Higgins PD. Orchard T. et al. Review article: defining remission in ulcerative colitis. Aliment Pharmacol Ther 2011; 34: 113-124
• 2 Iacucci M. Ghosh S. Mucosal healing – How deep is enough?. Dig Dis 2016; 34: 160-164
• 3 Frøslie KF. Jahnsen J. Moum BA. et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 2007; 133: 412-422
• 4 Peyrin-Biroulet L. Sandborn W. Sands BE. et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 2015; 110: 1324-1338
• 5 Kodashima S. Fujishiro M. Novel image-enhanced endoscopy with i-scan technology. World J Gastroenterol 2010; 16: 1043-1049
• 6 Esaki M. Kubokura N. Kudo T. et al. Endoscopic findings under narrow band imaging colonoscopy in ulcerative colitis. Dig Endosc 2011; 23 (Suppl. 01) 140-142
• 7 Hayashi S. Kudo SE. Ogata N. et al. Narrow-band imaging efficiency for evaluation of mucosal healing/ relapse of ulcerative colitis. Gastrointest Endosc 2016; 83 : AB154
• 8 Neumann H. Fujishiro M. Wilcox CM. et al. Present and future perspectives of virtual chromoendoscopy with i-scan and optical enhancement technology. Dig Endosc 2014; 26: 43-51
• 9 Schroeder KW. Tremaine WJ. Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 1987; 317: 1625-1629
• 10 Travis SP. Schnell D. Krzeski P. et al. Reliability and initial validation of the ulcerative colitis endoscopic index of severity. Gastroenterology 2013; 145: 987-995
• 11 Iacucci M. Fort Gasia M. Hassan C. et al. Complete mucosal healing defined by endoscopic Mayo subscore still demonstrates abnormalities by novel i-SCAN endoscopic and refined histological gradings. Endoscopy 2015; 47: 726-734
• 12 Mosli MH. Feagan BG. Zou G. et al. Development and validation of a histological index for UC. Gut 2017; 66: 50-58
• 13 Hefti MM. Chessin DB. Harpaz NH. et al. Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis. Dis Colon Rectum 2009; 52: 193-197
• 14 Barreiro-de Acosta M. Vallejo N. de la Iglesia D. Evaluation of the risk of relapse in ulcerative colitis according to the degree of mucosal healing (Mayo 0 vs 1): a longitudinal cohort study. J Crohns Colitis 2016; 10: 13-19
• 15 Bryant RV. Burger DC. Delo J. et al. Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut 2016; 65: 408-414
• 16 Choi CH. Ignjatovic-Wilson A. Askari A. et al. Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer. Am J Gastroenterol 2015; 110: 1461-1471