An International Multicenter Real-Life Prospective Study of Electronic Chromoendoscopy Score PICaSSO in Ulcerative Colitis

Abstract

BACKGROUND & AIMS: Endoscopic and histologic remission are important goals in the treatment of ulcerative colitis (UC). We investigated the correlation of the recently developed Paddington International Virtual ChromoendoScopy ScOre (PICaSSO) and other established endoscopic scores against multiple histological indices and prospectively assessed outcomes. METHODS: In this prospective multicenter international study, inflammatory activity was assessed with high-definition and virtual chromoendoscopy in the rectum and sigmoid using the Mayo Endoscopic Score (MES), UC Endoscopic Index of Severity (UCEIS), and PICaSSO. Targeted biopsies were taken for assessment using Robarts Histological Index (RHI), Nancy Histological index (NHI), ECAP (Extent, Chronicity, Activity, Plus score), Geboes, and Villanacci. Followup data were obtained at 6 and 12 months after colonoscopy. RESULTS: A total of 307 patients were recruited. There was strong correlation between PICaSSO and histology scores, significantly superior to correlation coefficients of MES and UCEIS with histology scores. A PICaSSO score of :::3 detected See editorial on page 1469.

Ultra-high Magnification Endocytoscopy and Molecular Markers for Defining Endoscopic and Histologic Remission in Ulcerative Colitis—An Exploratory Study to Define Deep Remission

“…We have recently reported that, even with high definition and electronic chromoendoscopy, endoscopic remission and histologic remission equally predict clinical outcomes at 1 year. 36 Thus endoscopy is getting closer to histology and AI might enable efficient use of endocytoscopy with minimal training and time.…”

Raman spectroscopy accurately differentiates mucosal healing from non-healing and biochemical changes following biological therapy in inflammatory bowel disease

“…Colonic mucosa was inspected, and precise assessments of inflammatory activity took place using high-definition white light endoscopy and Virtual Electronic Chromoendoscopy (Optical Enhancement iScan mode/Narrow-Band Imaging (NBI)) with and without magnification ( Fig 1A–1C ). Inflammatory activity was graded using the MES [ 10 ], Ulcerative Colitis Endoscopic Index of Severity (UCEIS) [ 16 ] and the PICaSSO score [ 7 , 9 ] in patients with UC and SES-CD in patients with CD [ 17 ]. Using these advanced endoscopic technologies and novel scores such as the PICaSSO score [ 9 ], targeted biopsies of inflamed/healed areas, which best reflected the overall inflammatory activity irrespective of colonic segment, were taken for ex vivo RS analysis and histological analysis at the same site.…”

“…Response to biological therapy was described as a reduction in endoscopic inflammatory activity score and in histological inflammatory score. The following stringent criteria were used to define patients with MH: MES [ 10 ] ≤1, UCEIS (Ulcerative colitis endoscopic index of severity) score [ 16 ] ≤1, PICaSSO score [ 7 , 9 ] ≤3 in addition to histological remission defined as RHI (Robarts Histological Index) score ≤3 without neutrophils in the epithelium and Lamina Propria [ 18 ] for UC. The following criteria were used to define MH in CD patients: SES-CD (Simple endoscopic score for Crohn’s disease) [ 17 ] ≤2 and a modified Riley score 0 in CD [ 19 ].…”

“…It is increasingly recognised that histological remission (HR) also predicts better outcomes [5,6], therefore definitions of MH is starting to incorporate endoscopic and histological remission. The recently published PICaSSO (The Paddington International Virtual Chromoendoscopy Score) score was developed to better define subtle mucosal and vascular changes of UC and for the first time introduced endoscopic findings of MH by using virtual electronic chromoendoscopy (VEC) [7][8][9]. This is an evolving field, which enables endoscopic assessments of subtle inflammatory changes.…”

Positionspapier zur Befunderstellung endoskopischer Untersuchungen bei Patienten mit chronisch-entzündlichen Darmerkrankungen

“…ausgerichtet. Zur Differenzierung innerhalb der weniger schweren Stadien, also v. a. zur differenzierten Betrachtung einer Mukosaheilung, wurde der PICASSO-Score mithilfe der virtuellen Chromoendoskopie validiert, der reproduzierbar eine Unterscheidung geringradiger entzündlicher Veränderungen von einer vollständigen Mukosaheilung zulässt [83,84]. Insgesamt wurde die Methodologie zur Erstellung neuer Messinstrumente zur Erfassung der endoskopischen Krankheitsaktivität bei C. ulcerosa in den letzten Jahren erheblich verfeinert.…”