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CC BY-NC-ND 4.0 · Endosc Int Open 2019; 07(08): E1018-E1026
DOI: 10.1055/a-0953-1334
Original article
Owner and Copyright © Georg Thieme Verlag KG 2019

Magnification endoscopy with optical chromoendoscopy shows strong correlation with histologic inflammation in patients with inflammatory bowel disease

Entcho Klenske
1   Department of Medicine I, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, University Hospital of Erlangen, University Erlangen-Nürnberg, Germany
,
Raja Atreya
1   Department of Medicine I, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, University Hospital of Erlangen, University Erlangen-Nürnberg, Germany
,
Arndt Hartmann
2   Institute of Pathology, University Hospital of Erlangen, University Erlangen-Nürnberg, Germany
,
Sarah Fischer
1   Department of Medicine I, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, University Hospital of Erlangen, University Erlangen-Nürnberg, Germany
,
Simon Hirschmann
1   Department of Medicine I, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, University Hospital of Erlangen, University Erlangen-Nürnberg, Germany
,
Sebastian Zundler
1   Department of Medicine I, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, University Hospital of Erlangen, University Erlangen-Nürnberg, Germany
,
Marietta Iaccuci
3   Institute of Translational Medicine, University of Birmingham, United Kingdom
,
Markus F. Neurath
1   Department of Medicine I, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, University Hospital of Erlangen, University Erlangen-Nürnberg, Germany
,
Timo Rath
1   Department of Medicine I, Division of Gastroenterology, Ludwig Demling Endoscopy Center of Excellence, University Hospital of Erlangen, University Erlangen-Nürnberg, Germany
› Author Affiliations
Further Information

Publication History

submitted 27 July 2018

accepted after revision 24 April 2019

Publication Date:
08 August 2019 (online)

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Abstract

Background and study aims Apart from mucosal healing as an established treatment goal in inflammatory bowel diseases (IBD), recent evidence suggests that histologic healing may become another key prognostic parameter in IBD patients. We aimed to evaluate whether magnification endoscopy with optical chromoendoscopy can accurately assess histologic inflammation in IBD patients.

Patients and methods In this prospective study, 82 patients with IBD (30 UC, 52 CD) were included. In all patients, magnification endoscopy in conjunction with optical chromoendoscopy was performed and rated on a novel magnification endoscopy score by three independent endoscopists. Targeted biopsies of the imaged areas were obtained and results were compared against two histological scores in UC (Robarts Histopathology Index, RHI; Nancy Histology Index, NHI) and one score in CD (modified Riley index, mRI). Moreover, interobserver agreement was calculated.

Results Magnification endoscopy showed strong correlation with histopathologic scoring in both UC (RHI: r = 0.83, NHI: r = 0.78, P < 0.05) and CD (mRI: r = 0.74, P < 0.05) with high accuracy, sensitivity, and specificity. Further, 25 % of patients with mucosal healing on standard endoscopy showed signs of microinflammation on magnification endoscopy with optical chromoendoscopy, while none of the patients with mucosal and vascular healing under magnification endoscopy with optical chromoendoscopy exhibited microscopic inflammation. Interobserver agreement for grading intestinal inflammation by magnification endoscopy with optical chromoendoscopy was substantial (κ > 0.7).

Conclusion Magnification endoscopy in combination with optical chromoendoscopy shows strong correlation with histologic inflammation in patients with IBD. This approach has potential to reduce physical biopsies for monitoring of inflammatory activity in patients with IBD during colonoscopy.

 

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