Endoscopy 2020; 52(S 01): S15
DOI: 10.1055/s-0040-1704053
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

COMPARISON OF ENDOSCOPIC HEALING, MUCOSAL BARRIER HEALING AND HISTOLOGIC HEALING FOR THE PREDICTION OF MAJOR CLINICAL EVENTS IN PATIENTS WITH INFLAMMATORY BOWEL DISEASES

T Rath
1   Ludwig Demling Endoscopy Center of Excellence, University Hospital Erlangen, Department of Gastroenterology, Erlangen, Germany
,
E Klenske
1   Ludwig Demling Endoscopy Center of Excellence, University Hospital Erlangen, Department of Gastroenterology, Erlangen, Germany
,
R Atreya
1   Ludwig Demling Endoscopy Center of Excellence, University Hospital Erlangen, Department of Gastroenterology, Erlangen, Germany
,
S Zundler
1   Ludwig Demling Endoscopy Center of Excellence, University Hospital Erlangen, Department of Gastroenterology, Erlangen, Germany
,
S Fischer
1   Ludwig Demling Endoscopy Center of Excellence, University Hospital Erlangen, Department of Gastroenterology, Erlangen, Germany
,
MF Neurath
1   Ludwig Demling Endoscopy Center of Excellence, University Hospital Erlangen, Department of Gastroenterology, Erlangen, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
23 April 2020 (online)

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Aims Probe-based confocal laser endomicroscopy (pCLE) enables microscopic imaging during ongoing endoscopy and can visualize mucosal barrier dysfunction (MBD) in IBD patients. Herein, we compared the prognostic value of endoscopic healing, mucosal barrier healing by pCLE and histologic healing for the prediction of major clinical events (MCE) in IBD patients.

Methods 180 IBD patients in clinical and endoscopic remission were prospectively enrolled. At study inclusion, HD WLE was performed to assess endoscopic disease activity and MBD was assessed by pCLE. In parallel, biopsies from each colonic segment were obtained for histopathologic scoring using established scores. Patients were followed-up for at least 12 months during which major clinical events (MCE: IBD-related hospitalization, need for surgery, need for initiation of systemic corticosteroids, immunosuppressants or biologics, escalation of existing biologic therapy) were recorded.

Results At the time of abstract submission, 104 IBD patients (38 UC, 68 CD) had finished follow-up of 12 months. In CD, assessment of MBD by pCLE exhibited an overall accuracy for predicting MCE of 84% with sensitivity, specificity, positive and negative prediction of 88%, 83%, 95% and 65%, respectively. Endoscopic healing and histologic healing were less accurate, less sensitive and also less specific in predicting MCE in CD patients (Endoscopic healing: accuracy: 55%, sensitivity: 39%, specificity: 71%; histologic healing: accuracy: 50%, sensitivity: 36%, specificity: 78%). Likewise, in UC, with an accuracy of 80%, a sensitivity of 88% and a NPV of 95%, assessing MBD by pCLE had a higher diagnostic performance for the prediction of MCE as compared to endoscopic and histologic healing (Endoscopic healing: accuracy: 71%, sensitivity: 65%, NPV: 68%; histologic healing: accuracy: 72%, sensitivity: 67%, NPV: 67%).

Conclusions By assessing MBD in vivo, pCLE allows predicting MCE in IBD patients in clinical end endoscopic remission with high sensitivity and seems to outcompete endoscopic and histologic healing in predicting longterm outcome.