Background and aims
Endoscopic remission is known to be defined as a Mayo endoscopic subscore (MES) of ≤1 in patients with ulcerative colitis (UC). However, some individuals experience relapse even after showing endoscopic remission under white-light imaging (WLI), and no tool exists that can detect these individuals. The aim of this study was to clarify the usefulness of texture and color enhancement imaging (TXI) in the assessment of inflammation in patients with UC.
This was a prospective, single-arm, observational study conducted at a university hospital. From January 2021 to December 2021, 146 UC patients with endoscopic remission were enrolled. Images were evaluated by WLI, TXI, and pathologic evaluation, followed by prognostic studies. The primary endpoint of the study was the cumulative relapse of UC in each TXI score. The secondary endpoints were the association between TXI and pathologic scores, predictors of relapse, and interobserver agreement between the MES and TXI scores.
Patients with TXI score 2 had significantly lower UC relapse-free rates than did those with TXI scores 0-1 (log-rank test, P < .01). When pathologic remission was defined as Matts grade ≤2, the rate of pathologic remission decreased significantly with higher TXI scores (P = .01). In multivariate analysis, TXI score 2 was the only risk factor for UC relapse (P < .01; hazard ratio, 4.16; 95% confidence interval, 1.72-10.04). Interobserver agreement on the TXI score was good (κ = 0.597-0.823).
TXI can be used to identify populations with poor prognosis in MES 1, for whom treatment intensification has been controversial.
Abbreviations:MES (Mayo endoscopic subscore), TXI (texture and color enhancement imaging), UC (ulcerative colitis), WLI (white-light imaging)
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Published online: November 29, 2022
Accepted: November 18, 2022
Received: July 26, 2022
Publication stageIn Press Journal Pre-Proof
DISCLOSURE: All authors disclosed no financial relationships.
This work was supported by a grant from the Japanese Foundation for Research and Promotion of Endoscopy.
© 2022 by the American Society for Gastrointestinal Endoscopy