Background and Aims
Apart from endoscopic healing as an established treatment goal in patients with inflammatory
bowel disease (IBD), histologic remission is an emerging endpoint that might even
better predict disease outcome, especially in ulcerative colitis (UC). Within this
study, we aimed to evaluate whether endocytoscopy (EC) as an in vivo contact microscopy
technology can accurately assess histologic inflammation and predict the further course
of disease in UC patients.
Methods
Initially, a new and intuitive EC score reflecting the entire spectrum of microscopic
disease activity in UC was consensually developed. Subsequently, this score was independently
validated in 46 patients with UC who underwent close-meshed follow-up during which
major adverse outcomes (MAOs; defined as disease flare, IBD-related hospitalization,
IBD-related surgery, necessity for initiation or escalation therapy) were recorded.
Results of EC grading of inflammatory activity were compared against 2 validated histologic
scores in UC. Diagnostic performance of endoscopic remission under white-light endoscopy
(Mayo Endoscopic Score and Ulcerative Colitis Endoscopic Index of Severity), EC, and
histology were compared for the prediction of MAOs.
Results
Endocytoscopic assessment of inflammatory activity in UC based on the newly developed
ErLangen Endocytoscopy in ColiTis score showed strong correlation with histopathologic
scoring (Robarts Histopathology Index, r = .70; Nancy Histologic Index, r = .73) and was superior to white-light endoscopy for grading of microscopic disease
activity, with a sensitivity of 88%, specificity of 95.2%, and area under the curve
of .916. Furthermore, EC exhibited a high interobserver agreement for in vivo grading
of microscopic inflammation and was comparably accurate as histopathology for forecasting
the occurrence of MAOs in UC.
Conclusions
Endocytoscopic grading of inflammatory activity along a newly developed scoring system
enabled real-time histology in UC patients and better predicted clinical outcome in
UC patients than endoscopic remission.
Abbreviations:
EC (endocytoscopy), ELECT (ErLangen Endocytoscopy for ColiTis), HD (high definition), IBD (inflammatory bowel disease), MAO (major adverse outcome), MES (Mayo Endoscopic Score), NHI (Nancy Histologic Index), RHI (Robarts Histopathology Index), UC (ulcerative colitis), UCEIS (Ulcerative Colitis Endoscopic Index of Severity), WLE (white-light endoscopy)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: September 01, 2022
Accepted:
August 19,
2022
Received:
April 28,
2022
Footnotes
DISCLOSURE: Dr Hartmann: Advisory board for BMS, MSD, Roche, Cepheid, Qiagen, Janssen, Astra Zeneca, Agilent, Lilly, Phäon, Ipsen, and Diaceutics; Speaker honoraria from, BMS, MSD, Roche, Astra Zeneca, Boehringer, Ingelheim, Abbvie, Janssen, Pfizer, Ipsen, and Diaceutics; Consultant for BMS, MSD, Roche, AstraZeneca, Boehringer Ingelheim, Abbvie, Janssen, Pfizer, Ipsen, and Diaceutics; Clinical trials for Janssen, Cepheid, AstraZeneca, and Roche; Research support from Illumina, Cepheid, Biontech, Roche, Janssen, Nanostring, and Astra Zeneca. All other authors disclosed no financial relationships.
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© 2023 by the American Society for Gastrointestinal Endoscopy
