Magnifying Endoscopic Findings Can Predict Clinical Outcome during Long-Term Follow-Up of More Than 12 Months in Patients with Ulcerative Colitis

Hajime Isomoto,Fuminao Takeshima,Kayoko Matsushima,Tomayoshi Hayashi,Junya Shiota,Chun Chuan Chen,Toshiyuki Nakayama,Kazuhiko Nakao,Ryohei Uehara

doi:10.1155/2013/671576

Hajime Isomoto, Fuminao Takeshima + Show 7 more

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https://doi.org/10.1155/2013/671576

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Abstract

Background and Aims. To explore the association of magnifying endoscopic (ME) findings with histopathology and relapse in ulcerative colitis (UC). Methods. Forty-six patients with UC underwent ME with narrow band imaging (NBI) and crystal violet staining and were followed for more than 12 months. ME findings with vital staining were classified into ME-A, regular arrangement of round to oval pits; ME-B, irregular arrangement with/without enlarged spaces between even pits; ME-C, irregular pits in size and shape with more irregular arrangement of pits; and ME-D, disrupted or disappeared pits. NBI-guided ME features of microvascular pattern (MVP) were divided into the MVP-regular and MVP-irregular type. Results. There were 5, 24, 10, and 7 cases of ME-A, ME-B, ME-C, and ME-D grade, respectively, while there were 21 and 25 of MVP-regular and MVP-irregular type, respectively. ME classifications were significantly associated with Matts endoscopic grade. ME classifications and MVP types were significantly associated with each pathognomonic microscopic feature of severe mucosal inflammation, crypt abscess, and goblet cell depletion. There were significant differences in the percentages of remission among ME classifications and between MVP types. Conclusion. ME findings can be predictive of relapse in UC and reliable for in vivo histopathological assessment.

Highlights

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by diffuse mucosal inflammation of the colorectum with exacerbations and remissions
The current study suggests that the magnifying endoscopic (ME) findings with vital staining and narrow band imaging (NBI) can predict clinical outcome of ulcerative colitis (UC) during longer-term follow-up
ME findings were classified into 4 types as follows: ME-A grade (ME-A), regular arrangement of normalappearing round to oval pits; ME-B, irregular arrangement of round to oval pits with/without enlarged spaces between the even crypts; ME-C, irregular pits in size and shape with more irregular arrangement of the pits compared to ME-B; and ME-D, destruction and disappearance of pits (Figure 1)

Summary

Introduction

Ulcerative colitis (UC) is a chronic inflammatory bowel disorder characterized by diffuse mucosal inflammation of the colorectum with exacerbations and remissions. The diagnosis of UC is obtained by incorporating clinical, laboratory, radiological, endoscopic, and histopathological findings [1]. There are discrepancies between colonoscopic and histopathological findings in patients with clinically inactive UC. Even when routine colonoscopy suggests remission with the normalappearing mucosa, that is, a common, standardized diagnosis of anatomic remission in accordance with the clinical feature, microscopic inflammatory abnormalities may persist and relapse may occur sooner or later. In the clinical setting of inactive UC, the disease relapse is difficult to be predicted by routine colonoscopy alone [1, 2]. To explore the association of magnifying endoscopic (ME) findings with histopathology and relapse in ulcerative colitis (UC). ME classifications and MVP types were significantly associated with each pathognomonic microscopic feature of severe mucosal inflammation, crypt abscess, and goblet cell depletion. ME findings can be predictive of relapse in UC and reliable for in vivo histopathological assessment

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Conclusion