Assessment of mucosal healing in inflammatory bowel disease (IBD) using Narrow Band Imaging (NBI) without optical magnification – A multicenter study

Introduction:

NBI is based on optical filters narrowing the red light therefore highlighting the vascular pattern morphology of the luminal gastrointestinal tract. Assessment of vascular changes in IBD is of pivotal importance for prediction of disease severity and extent and for guidance of pharmaceutical therapies. To date, no data is available on the use of NBI for assessment of mucosal healing in IBD.

Aims:

Study objective was to develop a classification system allowing for in vivo assessment of mucosal healing in IBD by using NBI without optical magnification.

Material and methods:

Consecutive patients with IBD underwent colonoscopy with high-definition endoscopes and NBI without optical magnification. The mucosal vascular and surface pattern morphology was recorded followed by targeted biopsies for subsequent histopathological diagnosis. Based on these findings a simplified classification was developed allowing for histologic prediction of the disease.

Results:

A simple classification system for assessment of mucosal healing by using NBI was developed. The classification system consists of 2 different parameters for the surface pattern morphology and 2 different parameters for the vascular pattern morphology. Sensitivity and specificity of the new classification for prediction of mucosal healing were calculated as 90% and 93%, respectively. Accuracy was calculated as 93% with positive and negative predictive values of 93% and 90%, respectively.

Conclusion:

To the best of our knowledge this is the first study proposing a unique classification system for in vivo assessment of mucosal healing in IBD with the NBI technology. The classification system allowed for adequate in vivo assessment of mucosal healing and might therefore be used to guide disease specific outcomes.