505 Clinical Significance of Endocytoscopic Findings in Ulcerative Colitis

Abstract

Clinical Significance of Endocytoscopic Findings in Ulcerative Colitis Kayoko Matsushima*, Hajime Isomoto, Ryohei Uehara, Junya Shiota, Yuko Akazawa, Naoyuki Yamaguchi, Ken Ohnita, Toshiyuki Nakayama, Tomayoshi Hayashi, Fuminao Takeshima, Kazuhiko Nakao Gastroenterology and Hepatology, Nagasaki University, Nagasaki, Japan; Pathology, Nagasaki University, Nagasaki, Japan Aim: To explore the association of endocytoscopic and magnified endoscopic findings with disease activity and relapse in patients with ulcerative colitis (UC). Methods: Forty mild to moderate UC patients underwent magnifying colonoscopy with crystal violet (CV) staining and/or NBI, and 24 patients underwent endocytoscopy (Olympus). Each case was classified into Matts’ grade 1 (n 14) or grade 2 (n 26) by Matts’ endoscopic grading. Those magnified endoscopic observation was specially referenced to microvascular abnormality and microsurface structures changes of glandular pits, and was compared to pathological characteristics including disease activity and extension, clinical course and relapse within 6 months. Results: On NBI, microvascular abnormalities including irregular, distorted or dilated microvessels and prominent lymphoid follicles were identified in 50% of all patients. Of note, 63.6% of patients with abnormal vessels and only 11.2% of patients with normal vessels had relapse (p 0.05). We classified CV-magnified chromoendoscopic findings into 5 grades as follows: CV-Grade1(G1); normal-appearing oval pits, CV-G2; irregular arrangement of round to oval pits, CV-G3; opening of intervening round to oval pits, CV-G4; irregular dilatation of pits, CV-G5; disappearance of pits. CV-grades of Matts’ grade 2 patients showed more severe than Matts’ grade 1 patients (CV-G4/5; 65.4% vs 0%, p 0.0001). In pathological findings, CV-G4/5 patients were associated with a higher incidence of inflammatory cells infiltration than CV-G13 (86.7% vs 26.1%, p 0.001). In the similar way, crypt abscess was shown in 73.3% vs 26.1% (p 0.01). Goblet cell depletion was shown in 86.7% vs 34.8%(p 0.005). Of clinical importance, 63.6% of CV-G4/5 patients experienced relapse within 6 months, whilst only 20% were experienced in CV-G13 patients (p 0.05). Endocytoscopy could detect grandular infiltration of cell components in accordance with histological features of severe inflammatory cell infiltration and crypt abscess. We classified endocytoscopic (EC) findings into 5 grades as follows: EC-G1; normal-appearing round pits with nominal inter-glandular cell components, EC-G2; oval pits with sparse inter-glandular cell components, ECG3; increased inter-glandular cell components, EC-G4; irregular dilation of pits with/without intra-glandular cell components, EC-G5; disruption or disappearance of pits. Each grade of EC findings was well matched for the each grade of CV-magnified endoscopic classification. Furthermore, the features of EC findings were remarkably similar to those pathological findings. Conclusion: The chromomagnifying endoscopic observation with CV could be rather predictive with respect to the disease activity and relapse in UC. Endocytoscopy seems to be promising to conjecture the severity of mucosal inflammation as well as disease relapse and activity.