DOP068 The virtual electronic chromoendoscopy score in ulcerative colitis exhibits very good inter-rater agreement in scoring mucosal and vascular changes after computerised module training: a study across academic and community practice

Abstract Background Mucosal healing is an important goal in the treatment of ulcerative colitis (UC). The newly published PICaSSO score characterises subtle mucosal and vascular changes and defines mucosal healing. We aimed to validate in real-life the PICaSSO score and assess its ability to predict relapse. Methods Patients with UC were prospectively recruited from 11 international centres. Participating endoscopists experienced in IBD received training on PICaSSO before starting the study. The rectum and sigmoid were examined using iScan 1,2 and 3 (Pentax, Japan) and inflammatory activity was assessed using UCEIS and PICaSSO. Biopsies were taken for the histological assessment using Robarts Histological Index (RHI) and Nancy. Follow-up was obtained at 12 months. Results A total of 278 patients were recruited (Table 1). The diagnostic performance in predicting histologic healing is shown in Table 2. When using PICaSSO score of ≤3 for mucosal and vascular architecture the AUROC to predict healing by RHI is 0.79 (95% CI 0.74–0.85) and 0.73 (95% CI 0.68–0.80) respectively and when using the Nancy score the AUROC is 0.78 (95% CI 0.72–0.84) and 0.77 (0.71–0.84). A total PICaSSO score of ≤8 and UCEIS score of ≤1 predicts remission at 12 months with an AUROC of 0.73 (0.65–0.80) and 0.71 (0.64–0.79). A Kaplan–Meier curve shows a favourable survival probability without relapse with a PICASSO score of ≤8 (Figure 1). Conclusion This real-life validation study shows the PICaSSO score can predict accurately histological healing and long-term remission and can be a useful tool in the management of UC.

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

Endoscopy ◽

10.1055/s-0042-124363 ◽

2017 ◽

Vol 49 (06) ◽

pp. 553-559 ◽

Cited By ~ 16

Author(s):

Marietta Iacucci ◽

Ralf Kiesslich ◽

Xianyong Gui ◽

Remo Panaccione ◽

Joan Heatherington ◽

...

Keyword(s):

Ulcerative Colitis ◽

Pilot Study ◽

Diagnostic Accuracy ◽

Mucosal Healing ◽

Mucosal Inflammation ◽

Vascular Changes ◽

Virtual Chromoendoscopy ◽

Acute Changes ◽

Inflammatory Changes ◽

Targeted Biopsies

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 < 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.

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Angiographic Evaluation of Vascular Changes in Ulcerative Colitis

Angiology ◽

10.1177/000331978003100301 ◽

1980 ◽

Vol 31 (3) ◽

pp. 147-153 ◽

Cited By ~ 8

Author(s):

Masaharu Tsuchiya ◽

Soichiro Miura ◽

Hitoshi Asakura ◽

Toshifumi Hibi ◽

Tadashi Tanaka ◽

...

Keyword(s):

Ulcerative Colitis ◽

Vascular Changes

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“One more time” 5-ASA retrial after a glucocorticosteroid induced remission in moderate to severe ulcerative colitis: A prospective community practice experience

Journal of Crohn s and Colitis ◽

10.1016/j.crohns.2012.07.018 ◽

2013 ◽

Vol 7 (4) ◽

pp. 342-343 ◽

Cited By ~ 2

Author(s):

Seth Lipka ◽

Seymour Katz ◽

Navroop Kaur

Keyword(s):

Ulcerative Colitis ◽

Community Practice ◽

Severe Ulcerative Colitis ◽

Practice Experience

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Inter-Observer Agreement of a New Endoscopic Score for Ulcerative Colitis Activity: Preliminary Experience

Diagnostics ◽

10.3390/diagnostics10040213 ◽

2020 ◽

Vol 10 (4) ◽

pp. 213

Author(s):

Mariabeatrice Principi ◽

Antonella Contaldo ◽

Francesco Paolo Bianchi ◽

Giuseppe Losurdo ◽

Andrea Iannone ◽

...

Keyword(s):

Ulcerative Colitis ◽

Scoring Systems ◽

Mucosal Damage ◽

Observer Agreement ◽

P Value ◽

Rater Agreement ◽

Colon Segment ◽

Endoscopic Score ◽

Web Platform

Ulcerative colitis (UC) endoscopic scores translate mucosal damage into values standardizing image analysis. Due to potential limits of current endoscopic activity indexes, we have elaborated on a new score, the “Extended Mayo Endoscopic Score (EMES),” and evaluated its inter-observer agreement in a multicenter endoscopy team, comparing concordance with the Mayo subscore. Sixteen UC consecutive patients underwent follow-up colonoscopy. Recorded videos were anonymously loaded on a web platform. Thirteen expert endoscopists evaluated UC activity using both Mayo and EMES. EMES was described in every colon segment: erythema (0: absent, 1: mild, 2: moderate, 3: severe), vascular pattern (0: normal, 1: reduction, 2: disappearance), erosions and ulcers (0: absent, 1: from 1 to 5, 2: 6 to 10, 3: >10). Weighted Fleiss’ kappa with 95% confidence interval (CI) and p-value defined inter-rater agreement. Global inter-observer agreement of EMES was moderate (kappa = 0.56, 95% CI = 0.46–0.67, p < 0.001). The evaluation of each colonic segment showed moderate agreement for all segments: ascending (kappa = 0.46, 95% CI = 0.32–0.60, p < 0.001), transverse (kappa = 0.48, 95% CI = 0.29–0.67, p < 0.001); descending (kappa = 0.49, 95% CI = 0.35–0.64, p < 0.001), sigmoid (kappa = 0.52, 95% CI = 0.39–0.65, p < 0.001) and rectum (kappa = 0.55, 95% CI = 0.42–0.69, p < 0.001). Mayo subscore agreement was similar to global EMES (kappa = 0.53, 95% CI = 0.39–0.66, p = 0.001). Therefore, our report emphasizes the importance of assessing inter-observer agreement for EMES, but also for other known scoring systems, including the Mayo subscore.

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An electron microscopic study of the intra-myocardial lesions in cases of acute myocardial infarction

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s042482010008328x ◽

1978 ◽

Vol 36 (2) ◽

pp. 484-485

Author(s):

Masahiro Ono ◽

Kaoru Aihara ◽

Gompachi Yajima

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Coronary Vessels ◽

Vascular Wall ◽

Vascular Changes ◽

Electron Microscopic ◽

Main Trunk ◽

Mechanical Destruction ◽

Transmission Electron ◽

Myocardial Lesions

The pathogenesis of the arteriosclerosis in the acute myocardial infarction is the matter of the extensive survey with the transmission electron microscopy in experimental and clinical materials. In the previous communication,the authors have clarified that the two types of the coronary vascular changes could exist. The first category is the case in which we had failed to observe no occlusive changes of the coronary vessels which eventually form the myocardial infarction. The next category is the case in which occlusive -thrombotic changes are observed in which the myocardial infarction will be taken placed as the final event. The authors incline to designate the former category as the non-occlusive-non thrombotic lesions. The most important findings in both cases are the “mechanical destruction of the vascular wall and imbibition of the serous component” which are most frequently observed at the proximal portion of the coronary main trunk.

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