Beyond white light: optical enhancement in conjunction with magnification colonoscopy for the assessment of mucosal healing in ulcerative colitis
submitted 12 September 2016
accepted after revision 05 December 2016
17 March 2017 (eFirst)
Background and study aim The I-SCAN optical enhancement (OE) system with magnification is a recently introduced combination of optical and digital electronic virtual chromoendoscopy, which enhances mucosal and vascular details. The aim of this pilot study was to investigate the use of I-SCAN OE in the assessment of inflammatory changes in ulcerative colitis (UC).
Patients and methods A total of 41 consecutive patients with UC and 9 control patients were examined by I-SCAN OE (Pentax Medical, Tokyo, Japan). Targeted biopsies of the imaged areas were obtained. A new optical enhancement score focusing on mucosal and vascular changes was developed. The diagnostic accuracy of I-SCAN OE was calculated against histology using two UC histological scores – Robarts Histopathology Index (RHI) and ECAP (Extent, Chronicity, Activity, Plus additional findings).
Results The overall I-SCAN OE score correlated with ECAP (r = 0.70; P < 0.001). The accuracy of the overall I-SCAN OE score to detect abnormalities by ECAP was 80 % (sensitivity 78 %, specificity 100 %). I-SCAN OE vascular and mucosal scores correlated with ECAP (r = 0.65 and 0.71, respectively; P < 0.001). The correlation between overall I-SCAN OE score and RHI was r = 0.61 (P < 0.01), and the accuracy to detect abnormalities by RHI was 68 % (sensitivity 78 %, specificity 50 %). The majority of patients with Mayo 0 had abnormalities on I-SCAN OE.
Conclusion In UC, the new I-SCAN OE technology accurately identified mucosal inflammation, and correlated well with histological scores of chronic and acute changes.
- 1 Travis SP. Higgins PD. Orchard T. et al. Review article: defining remission in ulcerative colitis. Aliment Pharmacol Ther 2011; 34: 113-124
- 2 Iacucci M. Ghosh S. Mucosal healing – How deep is enough?. Dig Dis 2016; 34: 160-164
- 3 Frøslie KF. Jahnsen J. Moum BA. et al. Mucosal healing in inflammatory bowel disease: results from a Norwegian population-based cohort. Gastroenterology 2007; 133: 412-422
- 4 Peyrin-Biroulet L. Sandborn W. Sands BE. et al. Selecting therapeutic targets in inflammatory bowel disease (STRIDE): determining therapeutic goals for treat-to-target. Am J Gastroenterol 2015; 110: 1324-1338
- 5 Kodashima S. Fujishiro M. Novel image-enhanced endoscopy with i-scan technology. World J Gastroenterol 2010; 16: 1043-1049
- 6 Esaki M. Kubokura N. Kudo T. et al. Endoscopic findings under narrow band imaging colonoscopy in ulcerative colitis. Dig Endosc 2011; 23 (Suppl. 01) 140-142
- 7 Hayashi S. Kudo SE. Ogata N. et al. Narrow-band imaging efficiency for evaluation of mucosal healing/ relapse of ulcerative colitis. Gastrointest Endosc 2016; 83 : AB154
- 8 Neumann H. Fujishiro M. Wilcox CM. et al. Present and future perspectives of virtual chromoendoscopy with i-scan and optical enhancement technology. Dig Endosc 2014; 26: 43-51
- 9 Schroeder KW. Tremaine WJ. Ilstrup DM. Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study. N Engl J Med 1987; 317: 1625-1629
- 10 Travis SP. Schnell D. Krzeski P. et al. Reliability and initial validation of the ulcerative colitis endoscopic index of severity. Gastroenterology 2013; 145: 987-995
- 11 Iacucci M. Fort Gasia M. Hassan C. et al. Complete mucosal healing defined by endoscopic Mayo subscore still demonstrates abnormalities by novel i-SCAN endoscopic and refined histological gradings. Endoscopy 2015; 47: 726-734
- 12 Mosli MH. Feagan BG. Zou G. et al. Development and validation of a histological index for UC. Gut 2017; 66: 50-58
- 13 Hefti MM. Chessin DB. Harpaz NH. et al. Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis. Dis Colon Rectum 2009; 52: 193-197
- 14 Barreiro-de Acosta M. Vallejo N. de la Iglesia D. Evaluation of the risk of relapse in ulcerative colitis according to the degree of mucosal healing (Mayo 0 vs 1): a longitudinal cohort study. J Crohns Colitis 2016; 10: 13-19
- 15 Bryant RV. Burger DC. Delo J. et al. Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up. Gut 2016; 65: 408-414
- 16 Choi CH. Ignjatovic-Wilson A. Askari A. et al. Low-grade dysplasia in ulcerative colitis: risk factors for developing high-grade dysplasia or colorectal cancer. Am J Gastroenterol 2015; 110: 1461-1471