Endoscopy 2020; 52(S 01): S14
DOI: 10.1055/s-0040-1704050
ESGE Days 2020 oral presentations
Friday, April 24, 2020 08:30 – 10:30 Endoscopy in flames Liffey Hall 1
© Georg Thieme Verlag KG Stuttgart · New York

THE FIRST REAL-LIFE MULTICENTRE, PROSPECTIVE VALIDATION STUDY OF THE ELECTRONIC CHROMOENDOSCOPY SCORING SYSTEM (PICASSO-THE PADDINGTON INTERNATIONAL VIRTUAL CHROMOENDOSCOPY SCORE) AND ITS OUTCOME IN ULCERATIVE COLITIS

M Iacucci
1   Institute of Translational Medicine, Birmingham, United Kingdom
2   NIHR Birmingham Biomedical Research Centre, Gastroenterology, Birmingham, United Kingdom
,
S Smith
1   Institute of Translational Medicine, Birmingham, United Kingdom
,
A Bazarova
1   Institute of Translational Medicine, Birmingham, United Kingdom
,
U Shivaji
1   Institute of Translational Medicine, Birmingham, United Kingdom
2   NIHR Birmingham Biomedical Research Centre, Gastroenterology, Birmingham, United Kingdom
,
P Bhandari
3   Queen Alexandra Hospital, Gastroenterology, Portsmouth, United Kingdom
,
R Cannatelli
1   Institute of Translational Medicine, Birmingham, United Kingdom
,
M Daperno
4   University of Torino, Gastroenterology, Turin, United Kingdom
,
JG Ferraz
5   University of Calgary, Gastroenterology, Calgary, Canada
,
M Goetz
6   Klinikum Boblingen, Gastroenterology, Boblingen, Germany
,
X Gui
7   University of Washington, Pathology, Seattle, United States of America
,
B Hayee
8   King’s College London, Gastroenterology, London, United Kingdom
,
GD Hertogh
9   University Hospitals Leuven, Pathology, Leuven, Belgium
,
M Lazarev
10   Johns Hopkins University, Gastroenterology, Baltimore, United States of America
,
J Li
11   Peking Union Medical College Hospital, Gastroenterology, Beijing, China
,
OM Nardone
1   Institute of Translational Medicine, Birmingham, United Kingdom
,
V Occhipinti
12   IRCCS Policlinico San Donato, Gastroenterology, Milan, Italy
,
R Panaccione
5   University of Calgary, Gastroenterology, Calgary, Canada
,
A Parra-Blanco
13   University of Nottingham, Gastroenterology, Nottingham, United Kingdom
,
L Pastorelli
12   IRCCS Policlinico San Donato, Gastroenterology, Milan, Italy
,
T Rath
14   University of Erlangen, Gastroenterology, Erlangen, Germany
,
GE Tontini
15   University of Milan, Pathophysiology and Transplantation, Milan, Italy
,
M Vieth
16   Kinikum Bayreuth, Pathology, Bayreuth, Germany
,
V Villanacci
17   Institute of Pathology Spedali Civili Brescia, Pathology, Brescia, Italy
,
D Zardo
18   University Hospitals Birmingham NHS Foundation Trust, Pathology, Birmingham, United Kingdom
,
R Kiesslich
19   Helios HSK Wiesbaden, Gastroenterology, Wiesbaden, Germany
,
R Bisschops
20   University Hospitals Leuven, Gastroenterology, Leuven, Belgium
,
S Ghosh
1   Institute of Translational Medicine, Birmingham, United Kingdom
2   NIHR Birmingham Biomedical Research Centre, Gastroenterology, Birmingham, United Kingdom
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

 

Aims Mucosal healing is an important goal in the treatment of ulcerative colitis (UC). The newly published PICaSSO score characterises subtle mucosal and vascular changes and defines mucosal healing. We aimed to validate in real-life the PICaSSO score and assess its ability to predict relapse.

Tab. 1

Sensitivity (a), specificity (b) and accuracy (c) in predicting histological healing

Endoscopic score

RHI (≤3) (95%CI)

Nancy (≤1)(95%CI)

PICaSSO total score (≤8) a, b, c

94.6%(71.9-97.6), 57.7%(32.7-66.9), 79.9%(70.0-93.5)

78.8%(37.4-86.6), 64.8%(28.5-73.6), 67.6%(63.3-71.2)

PICaSSO Mucosal architecture (≤3) a, b, c

93.4%(81.8-97.6), 56.8%(41.4-66.7), 78.8%(72.4-82.7)

97.1%(56.5-99.4), 63.9%(35.6-73.1), 84.2%(72.9-88.0)

PICaSSO Vascular Architecture (≤3) a, b, c

74.9%(51.2-84.5), 65.8%(55.1-74.2), 71.2%(67.0-74.6)

78.8%(37.4-86.6), 73.1%(61.8-80.6), 76.6%(72.0-79.6)

UCEIS Score (≤1) a, b, c

91.6%(77.6-95.8), 60.4%(45.0-68.5), 79.1%(73.3-82.6)

93.5%(57.8-97.8), 64.8%(53.1-73.1), 82.3%(77.9-85.6)

Methods Patients with UC were prospectively recruited from 11 international centres. Participating endoscopists experienced in IBD received training on PICaSSO before starting the study. The rectum and sigmoid were examined using iScan 1,2&3 (Pentax, Japan) and inflammatory activity was assessed using UCEIS and PICaSSO. Biopsies were taken for histological assessment using Robarts Histological Index (RHI) and Nancy. Follow up data was obtained at 12 months.

Results A total of 278 patients were recruited. The diagnostic performance in predicting histologic healing is shown in table 1. When using PICaSSO score of ≤3 for mucosal and vascular architecture the AUROC to predict healing by RHI is 0.79 (95% CI 0.74-0.85) and 0.73 (95% CI 0.68-0.80) respectively and when using the Nancy score the AUROC is 0.78 (95% CI 0.72-0.84) and 0.77 (0.71-0.84). A total PICaSSO score of ≤8 and UCEIS score of ≤1 predicts remission at 12 months with an AUROC of 0.73 (0.65-0.80) and 0.71 (0.64-0.79). Kaplan-Meier curve shows favourable survival probability without relapse with a PICASSO score of ≤8.

Conclusions This real-life validation study shows the PICaSSO score can predict accurately histological healing and long-term remission and can be a useful tool in the management of UC.