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CC BY-NC-ND 4.0 · Endosc Int Open 2020; 08(01): E41-E49
DOI: 10.1055/a-0990-9375
Original article
Owner and Copyright © Georg Thieme Verlag KG 2020

A novel endoscopic imaging system for quantitative evaluation of colonic mucosal inflammation in patients with quiescent ulcerative colitis

Yusuke Honzawa
1   Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
,
Minoru Matsuura
1   Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
,
Hirokazu Higuchi
2   Department of Medical Supply, Kyoto University Hospital, Kyoto, Japan
,
Takaki Sakurai
3   Laboratory of Anatomic Pathology, Kyoto University Hospital, Kyoto, Japan
,
Hiroshi Seno
1   Department of Gastroenterology and Hepatology, Kyoto University Hospital, Kyoto, Japan
,
Hiroshi Nakase
4   Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
› Author Affiliations
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Publication History

submitted 02 March 2019

accepted after revision 05 July 2019

Publication Date:
08 January 2020 (online)

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Abstract

Background and study aims Mucosal healing (MH) is associated with clinical outcome in ulcerative colitis (UC) patients. In most clinical trials, a Mayo endoscopic subscore (MES) of 0 or 1 is defined as MH. However, several recent studies have reported that clinical outcome is different between UC patients with MES 0 and those with MES 1. In addition, the MES is subjective and may differ among endoscopists. Therefore, a repeatable and objective scoring system is required to distinguish MES 0 from MES 1, even in clinically quiescent UC. Here, we assessed the usefulness of new image-enhancing endoscopic technology, the i-scan TE-c, to quantitatively evaluate colonic inflammation in patients with quiescent UC.

Methods We retrospectively reviewed the data from 52 UC patients in clinical remission who had undergone routine colonoscopy with standard white light. The white-light images were reassessed using the new system, and the degree of colonic mucosal inflammation was quantified according to the MAGIC (Mucosal Analysis of Inflammatory Gravity by i-scan TE-c Image) score. We used the i-scan TE-c system to investigate the association among the MAGIC score, MES, and histologic activity (Geboes score).

Results The MAGIC score was significantly higher in the MES 1 group than in the MES 0 group (P = 0.0034). The MAGIC score significantly correlated with the Geboes score (P = 0.015).

Conclusions Our novel image-enhancing endoscopic system was useful for objective and quantitative evaluation of MH in patients with quiescent UC. Further clinical studies using this imaging system are required to confirm its clinical benefit for the management of UC patients.

 

  • References

  • 1 Baumgart DC, Sandborn WJ. Inflammatory bowel disease: clinical aspects and established and evolving therapies. Lancet 2007; 369: 1641-1657
    CrossrefPubMedGoogle Scholar
  • 2 Abraham C, Cho JH. Inflammatory bowel disease. NEJM 2009; 361: 2066-2078
    CrossrefPubMedGoogle Scholar
  • 3 Froslie 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
    CrossrefPubMedGoogle Scholar
  • 4 Colombel JF, Rutgeers P, Reinisch W. et al. Early mucosal healing with infliximab is associated with improved long-term clinical outcomes in ulcerative colitis. Gastroenterology 2011; 141: 1194-1201
    CrossrefPubMedGoogle Scholar
  • 5 Dulai PS, Levesque BG, Feagan BG. et al. Assessment of mucosal healing in inflammatory bowel disease: review. Gastrointest Endosc 2015; 82: 246-255
    CrossrefPubMedGoogle Scholar
  • 6 Schoeder KW, Tremaine WJ, IIstrup DM. et al. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. NEJM 1987; 317: 1625-1629
    CrossrefPubMedGoogle Scholar
  • 7 Meucci G, Fasoli R, Saibeni S. et al. Prognostic significance of endoscopic remission in patients with active ulcerative colitis treated with oral and topical mesalazine: a prospective, multicenter study. Inflamm Bowel Dis 2012; 18: 1006-1010
    CrossrefPubMedGoogle Scholar
  • 8 Samaan MA, Mosli MH, Sandborn WJ. et al. A systematic review of the measurement of endoscopic healing in ulcerative colitis clinical trials: recommendations and implications for future research. Inflamm Bowel Dis 2014; 20: 1465-1471
    CrossrefPubMedGoogle Scholar
  • 9 Barreiro-de Acosta M, Vallejo N, de la Iglesia D. et al. 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
    CrossrefPubMedGoogle Scholar
  • 10 Fiorino G, Cesarini M, Indriolo A. et al. Mucosal healing in ulcerative colitis: where do we stand?. Curr Drug Targets 2011; 12: 1417-1423
    CrossrefPubMedGoogle Scholar
  • 11 Peyrin-Biroulet L, Ferrante M, Magro F. et al. Impact of mucosal healing on the course of inflammatory bowel disease. J Crohns Colitis 2011; 5: 477-483
    CrossrefPubMedGoogle Scholar
  • 12 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
    CrossrefPubMedGoogle Scholar
  • 13 Bitton A, Peppercorn MA, Antonioli DA. et al. Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 2001; 120: 13-20
    CrossrefPubMedGoogle Scholar
  • 14 Riley SA, Mani V, Goodman MJ. et al. Microscopic activity in ulcerative colitis: what does it mean?. Gut 1991; 32: 174-178
    CrossrefPubMedGoogle Scholar
  • 15 Geboes K, Riddell R, Ost A. et al. A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut 2000; 47: 404-409
    CrossrefPubMedGoogle Scholar
  • 16 Kunihiro M, Tanaka S, Sumii M. et al. Magnifying colonoscopic features of ulcerative colitis reflect histologic inflammation. Inflamm Bowel Dis 2004; 10: 737-744
    CrossrefPubMedGoogle Scholar
  • 17 Sanduleanu S, Kaltenbach T, Barkun A. et al. A roadmap to the implementation of chromoendoscopy in inflammatory bowel disease colonoscopy surveillance practice. Gastrointest Endosc 2016; 83: 213-222
    CrossrefPubMedGoogle Scholar
  • 18 Kodashima S, Fujishiro M. Novel image-enhanced endoscopy with i-scan technology. World J Gastroenterol 2010; 16: 1043-1049
    CrossrefPubMedGoogle Scholar
  • 19 Iacucci M, Daperno M, Lazarev M. et al. Development and reliability of the new endoscopic virtual chromoendoscopy score: the PICaSSO (Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis. Gastrointest Endosc 2017; 86: 1118-1127
    CrossrefPubMedGoogle Scholar
  • 20 Tontini GE, Vecchi M, Neurath MF. et al. Review article: newer optical and digital chromoendoscopy techniques vs. dye-based chromoendoscopy for diagnosis and surveillance in inflammatory bowel disease. Aliment Pharmacol Ther 2013; 38: 1198-1208
    CrossrefPubMedGoogle Scholar
  • 21 Maeda Y, Ohtsuka K, Kudo SE. et al. Endocytoscopic narrow-band imaging efficiency for evaluation of inflammatory activity in ulcerative colitis. World J Gastroenterol 2015; 21: 2108-2115
    CrossrefPubMedGoogle Scholar
  • 22 Iacucci M, Furfaro F, Matsumoto T. et al. Advanced endoscopic techniques in the assessment of inflammatory bowel disease: new technology, new era. Gut 2019; 68: 562-572
    CrossrefPubMedGoogle Scholar
  • 23 Iacucci M, Fort GasiaM, Hassan C. et al. Complete mucosal healing defined by endoscopic Mayo subscore still demonstrates abnormalities by novel high definition colonoscopy and refined histological gradings. Endoscopy 2015; 47: 726-734
    Article in Thieme ConnectPubMedGoogle Scholar
  • 24 Neumann H, Vieth M, Günther C. et al. Virtual chromoendoscopy for prediction of severity and disease extent in patients with inflammatory bowel disease: a randomized controlled study. Inflamm Bowel Dis 2013; 19: 1935-1942
    PubMedGoogle Scholar
  • 25 Schroeder KW, Tremaine WJ, Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis: a randomized study. NEJM 1987; 317: 1625-1629
    CrossrefPubMedGoogle Scholar
  • 26 Boal Carvalho P, Dias de Castro F, Rosa B. et al. Mucosal healing in ulcerative colitis – When zero is better. J Crohns Colitis 2016; 10: 20-25
    CrossrefPubMedGoogle Scholar
  • 27 Sasanuma S, Ohtsuka K, Kudo SE. et al. Narrow band imaging efficiency in evaluation of mucosal healing/relapse of ulcerative colitis. Endosc Int Open 2018; 6: E518-E523
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Iacucci M, Kiesslich R, Gui X. et al. Beyond white light: optical enhancement in conjunction with magnification colonoscopy for the assessment of mucosal healing in ulcerative colitis. Endoscopy 2017; 49: 553-559
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Lemmens B, Arijs I, Van Assche G. et al. Correlation between the endoscopic and histologic score in assessing the activity of ulcerative colitis. Inflamm Bowel Dis 2013; 19: 1194-1201
    CrossrefPubMedGoogle Scholar
  • 30 Jauregui-Amezaga A, Geerits A, Das Y. et al. A simplified Geboes score for ulcerative colitis. J Crohns Colitis 2017; 11: 305-313
    PubMedGoogle Scholar
  • 31 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
    CrossrefPubMedGoogle Scholar