Abstract
Background
Endoscopic remission is the ideal treatment goal for patients with ulcerative colitis (UC) in clinical practice. However, several recent investigations tried to evaluate histological healing as a more optimal treatment goal. The assessment of histological healing, however, is usually inconvenient and time-consuming because of the requirement of a biopsy and pathological assessment. Dual red imaging (DRI; Olympus Corporation, Japan) is a novel image enhanced endoscopy technique that can visualise the inflammation, including that in the surface crypt, and vessel findings of the brownish surface or green-coloured deeper layer of the mucosa in contrast to narrow band imaging. We preliminarily evaluated the utility of DRI in the assessment of histological healing in UC as a practical approach.
Methods
We enrolled UC patients who provided consent from May 2018 to September 2019 in our hospital, and performed colonoscopy in the entire colon with white-light imaging and DRI, and then endoscopic pictures and biopsy samples were obtained. Central pathological assessment of histological inflammation based on the Nancy index with individual items was performed for each biopsy sample. We also assessed the clinical background, UC activity according to the Mayo score, white-light endoscopic activity according to the Mayo endoscopic subscore (MES), and DRI findings using a 5-point scale.
Results
We evaluated a total of 90 sets of DRI and pathological findings from 47 UC patients (20 females; median age, 42 [20–84] years; 25 with pancolitis, 17 left-sided colitis, 3 proctitis, and 2 others; median duration of disease, 83 [1–379] months; median Mayo score, 2 [0–11]). Participants were treated with 5-aminosalicylates (38 oral; 7 topical), steroid (4 systemic; 6 topical), immunomodulator (7), anti-TNF agents (5), tofacitinib (3), and tacrolimus (8). Both the MES (r = 0.70) and DRI scale (r = 0.65) correlated well with the Nancy index. Among individual pathological items with respect to inflammation, ulceration (r = 0.69), chronic inflammatory infiltrate (r = 0.66), neutrophils in the lamina propria (r = 0.65), and serrated architectural abnormalities (r = 0.60) correlated well with the Nancy index in contrast to other pathological items. DRI seemed to facilitate the visualisation of histological inflammation in deeper layers of the mucosa compared with white-light imaging or narrow-band imaging.
Conclusion
The novel DRI technique has potential in the evaluation of histological inflammation without the requirement of a biopsy in patients with UC as a practical approach. A further prospective multicenter study in this regard is needed.
Clinical usefulness of narrow band imaging magnifying colonoscopy for assessing ulcerative colitis-associated cancer/dysplasia
