Beyond white light:optical enhancement in conjunction with magnification colonoscopy for the assessment of mucosal healing in ulcerative colitis

Abstract 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 &lt; 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 &lt; 0.001). The correlation between overall I-SCAN OE score and RHI was r = 0.61 (P &lt; 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.</jats:p

Fecal Calprotectin Thresholds to Predict Endoscopic Remission Using Advanced Optical Enhancement Techniques and Histological Remission in IBD Patients.

BACKGROUND Fecal calprotectin (FC) is a common surrogate marker of mucosal healing (MH) in patients with ulcerative colitis (UC) and Crohn's disease (CD). We investigated the optimum FC thresholds for defining endoscopic remission (ER) and histological remission (HR) using advanced endoscopic techniques. PATIENTS AND METHODS In this cross-sectional study, we collected clinical, endoscopic, histological data, and FC from 76 UC and 41 CD patients. Receiver operating characteristic curves were created to evaluate the optimum cut-off of FC to predict ER evaluated by Mayo Endoscopic Score (MES), Ulcerative Colitis Endoscopic Index of Severity (UCEIS), and modified PICaSSO (Paddington International Virtual Chromoendoscopy Score) for UC patients and Simple Endoscopic Score (SES-CD) in CD patients; and HR was scored by the Robarts Histology Index (RHI) and Nancy Index for UC and modified Riley for CD. RESULTS In UC patients, the best thresholds of FC to identify ER calculated with MES, UCEIS, and modified PICaSSO were 112, 148, and 161 mcg/g with accuracy of 86.9% 86.8%, and 81.6%, respectively. The best value of FC to predict HR was 112 mcg/g and 172 mcg/g with accuracy of 84.2% and 81.6% for RHI and Nancy Index, respectively.In CD patients, the best cut-off of FC to predict ER was 96 mcg/g with accuracy of 82.9%. The HR was best predicted by an FC value of 225 mcg/g with accuracy of 75.6%. CONCLUSIONS The FC value threshold between 112 and 172 mcg/g could identify ER and HR in UC patients, whereas a value under 225 mcg/g should be considered for CD patients

Assessment of endoscopic healing by using advanced technologies reflects histologic healing in ulcerative colitis.

BACKGROUND Several studies reported that Ulcerative colitis (UC) patients with endoscopic mucosal healing may still have histologic inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO (Paddington International Virtual ChromoendoScopy ScOre), Mayo Endoscopic Score (MES) and probe-based confocal laser endomicroscopy (pCLE) with histological indices in UC. METHODS A prospective study enrolling 82 UC patients (M 66%) was conducted. High definition (HD) colonoscopy was performed to evaluate the activity of the disease with MES assessed with High Definition (HD-MES) and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver Operating Characteristic (ROC) curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index (RHI) and ECAP 'Extension, Chronicity, Activity, Plus' histology score. RESULTS A modified PICaSSO of ≤4 predicted histological healing at RHI ≤3, with sensitivity, specificity, accuracy and area under the ROC curve (AUROC) of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7, 85.4% and 92.1%, respectively. A pCLE ≤10 predicted histological healing with sensitivity 94.9%, specificity 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤10 was predicted by modified PICaSSO ≤4 with accuracy of 91.5% and AUROC of 95.9%. CONCLUSION Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic Chromoendoscopy PICaSSO,endoscopic score ; and the use of pCLE did not improve the accuracy any further

Erratum to: Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition) (Autophagy, 12, 1, 1-222, 10.1080/15548627.2015.1100356

non present