Assessment of Endoscopic Healing by Using Advanced Technologies Reflects Histological Healing in Ulcerative Colitis

Abstract

Background Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO [Paddington International Virtual ChromoendoScopy ScOre], Mayo Endoscopic Score [MES] and probe-based confocal laser endomicroscopy [pCLE] with histological indices in UC. Methods A prospective study enrolling 82 UC patients [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [HD-MES] and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver operating characteristic [ROC] curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index [RHI] and ECAP ‘Extension, Chronicity, Activity, Plus’ histology score. Results A modified PICaSSO of ≤ 4 predicted histological healing at RHI ≤ 3, with sensitivity, specificity, accuracy and area under the ROC curve [AUROC] of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7%, 85.4% and 92.1%, respectively. A pCLE ≤ 10 predicted histological healing with sensitivity of 94.9%, specificity of 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤ 10 was predicted by modified PICaSSO ≤ 4 with accuracy of 91.5% and AUROC of 95.9%. Conclusion Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic chromoendoscopy PICaSSO, endoscopic score; and the use of pCLE did not improve the accuracy any further.

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

“…[24][25][26] HR may predict favorable patient outcomes, [27][28][29] and we have demonstrated that the PICaSSO score of 3 not only describes endoscopically quiescent disease but is also associated with HR with a high degree of accuracy and low false negative rate. This confirms our recent findings with a single operator using multiple endoscopic platforms, 10 with clinical and fecal calprotectin endpoints 30 reinforcing the concept that endoscopic assessment is getting closer to histology using current generation endoscopes. VEC is a technology that is widely available at the push of a button, routinely used for better characterization of gastrointestinal cancers, and does not require additional time.…”

“…This may be the consequence of assessment by HD experienced operators and training modules before start of the study. 9,10,32,33 UCEIS in a previous study reported moderate interobserver agreement, 34 and correlated strongly with the NHI and RHI, but this study was single-center, single-endoscopist and -pathologist design. 35 For an endoscopic score to be useful clinically, a cutoff to indicate likelihood of long-term outcome of remission is desirable.…”

“…8,9 Currently available advanced imaging using high-definition (HD) endoscopy, with virtual electronic chromoendoscopy (VEC), can enhance mucosal and vascular details. 10 Therefore, there is need for a score that accurately describes ER not just as absence of mucosal changes but with a better correlation to HR. Initial studies have shown that with the current generation of endoscopic equipment with VEC, subtle mucosal and vascular changes may reflect histology.…”

“…Initial studies have shown that with the current generation of endoscopic equipment with VEC, subtle mucosal and vascular changes may reflect histology. 9,10 The recently developed, validated, and reproduced Paddington International virtual ChromoendoScopy ScOre (PICaSSO), is the first to use VEC to assess vascular and mucosal features of healing. 11 Moreover, the PICaSSO score performed better than MES and the Ulcerative Colitis Endoscopic index of Severity (UCEIS) 12 to predict HR in a single-center study.…”

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

“… 15 , 16 We have demonstrated that with widely available advanced technologies such as virtual electronic chromoendoscopy (VEC) and high definition (HD) imaging, endoscopic and histologic scores correlate more strongly and reduced discrepancy between the two, unlike previous publications. 17–19 This has also been shown using artificial intelligence approach utilizing deep neural network approach. 20 , 21 Among these new endoscopic armamentarium, endocytoscopy (ECS; CF- Y-0058-1 prototype, Olympus Japan) is a new technique that provides in vivo microscopic imaging during endoscopy, with ultra-high magnification ranging from 450-fold to 1400-fold, looking at cells and nuclei of mucosal surfaces.…”