The efficacy of linked color imaging for the endoscopic diagnosis of mucosal healing in quiescent ulcerative colitis

Abstract

Background and Aim The Mayo Endoscopic Subscore (MES) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) are used to assess endoscopic mucosal healing in patients suffering from ulcerative colitis. Although mucosal healing is defined by MES 0, relapse of ulcerative colitis is often observed. Over a 48‐month period, this study investigated the efficacy of linked color imaging (LCI) in predicting the long‐term prognosis of ulcerative colitis patients diagnosed with MES 0. Methods Overall, 26 patients in ulcerative colitis remission, diagnosed with MES 0, were enrolled. Using a LASEREO endoscopic system (Fujifilm Co., Tokyo, Japan), endoscopic colonic images were assessed with linked color imaging and the colitis endoscopic index of severity. Endoscopic LCI images were separated into three subgroups (A, no redness; B, redness with visible vessels; and C, redness without visible vessels). The Geboes score was used to evaluate histology; active mucosa was defined as GS > 2B.1. Results Linked color imaging classification subdivided colonic mucosa, which had been diagnosed with MES 0, into two classes. The LCI‐A group did not relapse, and the non‐relapse rate was significantly higher (P = 0.018) than that in the LCI‐B group. No difference in relapse rates was observed between patients with a colitis endoscopic index of severity of 0 and 1 (P = 0.655). There was no statistical difference between the composition of LCI‐A group and the relapse rate between active and inactive mucosa diagnosed by Geboes score. Conclusions This methodology can be used to evaluate mucosal healing and predict long‐term outcomes in ulcerative colitis patients.

Mucosal interleukin‐8 expression as a predictor of subsequent relapse in ulcerative colitis patients with Mayo endoscopic subscore 0

“…However, it is important to note that even in cases diagnosed as MES 0, a 9.4% relapse was observed. In recent studies that included the endoscopic mucosal evaluation of UC, there have been several reports of relapse in patients presenting with MES 0 mucosa, including 20.0% at 12 months, 16 28.6% at 30 months, 17 18.8% at 80 months, 18 25.9% at 48 months, 19 and 9.2% at 400 days 20 of observation. These results suggest that the diagnosis of MH by endoscopy, defined as MES 0, is not sufficient to predict subsequent clinical relapse.…”

Possible Role of Image-Enhanced Endoscopy in the Evaluation of Mucosal Healing of Ulcerative Colitis

“…According to these data, inactive colonic mucosa with an MES of 0 or 1 on WLI could be further subdivided by LCI, suggest- ing that the LCI classification was independent of the MES. Furthermore, Takagi et al [20] subdivided the LCI classification of colonic mucosa diagnosed with an MES of 0 on conventional WLI into two classes, LCI-A and LCI-B, and compared the relapse rate and histologic activity between the two groups. They showed that the relapse rate of patients with LCI-A was significantly higher than in those with LCI-B over a 48-month follow-up period, even in patients with quiescent UC with an MES of 0 on conventional WLI (100%, 9/9 vs. 52.9%, 9/17, respectively, p = 0.018).…”

Application of linked color imaging in the diagnosis of early gastrointestinal neoplasms and precancerous lesions: a review

“…Studies using LCI in patients with UC have shown that endoscopic LCI assessment is closely associated with Matts histopathological grade. 39 Recent studies have shown that LCI assessment can accurately predict the recurrence of UC in patients with clinical remission and MES of 0, 40 and can better reflect the prognosis of patients than MES grading. 41 As a new method that can define endoscopic mucosal healing, LCI is a promising tool for predicting the clinical recurrence of UC.…”