scholarly journals Development and Validation of a Confocal Laser Endomicroscopy-Based Score for In Vivo Assessment of Mucosal Healing in Ulcerative Colitis Patients

2017 ◽  
Vol 24 (1) ◽  
pp. 35-44 ◽  
Author(s):  
Gheorghe Hundorfean ◽  
Mircea T Chiriac ◽  
Sidonia Mihai ◽  
Arndt Hartmann ◽  
Jonas Mudter ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
High Sensitivity ◽  
Mucosal Healing ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Mayo Score ◽  
Before And After ◽  
Sensitivity Specificity ◽  
Development And Validation

Abstract Background Endoscopic monitoring is fundamental for evaluating the therapeutic response in IBD, but a validated endomicroscopic mucosal healing (MH) score is not available to date. However, confocal laser endomicroscopy (CLE) might define MH more precisely than conventional endoscopy. The major aim was to establish and validate an MH score for ulcerative colitis (UC), based on CLE. Methods In an initial pilot study (n = 10), various CLE changes were analyzed for identification of reproducible criteria for establishing a CLE score. Four reproducible CLE criteria were implemented in a following validation study. Subsequently, active UC patients (n = 23, Mayo score ≥6) were prospectively included and underwent colonoscopy with CLE before and after 3 anti-TNF applications. Patients were clinically followed over a period of 3 years. The endomicroscopic MH score (eMHs; range, 0–4) was compared with histopathology and endoscopy scores from the same colonic location. Results The eMHs showed high sensitivity, specificity, and accuracy values (100% with 95% confidence interval [CI] of 15.81%–100%; 93.75% with 95% CI of 69.77%–99.84%, and 94.44%, respectively). The eMHs showed a good correlation with the histological Gupta score (rs = 0.82, P < 0.0001) and the endoscopic Mayo subscore (rs = 0.81%, P < 0.0001). Sixty percent of therapy responders presented an eMHs <1, which translated into long-lasting clinical remission and reduced hospitalization, steroid, and surgery need. Conclusions CLE can accurately assess MH based on the newly developed and statistically validated eMHs in UC, and it is superior in predicting the long-lasting clinical outcome based on both descriptive and functional barrier imaging (NCT01417728).

Assessment of Endoscopic Healing by Using Advanced Technologies Reflects Histological Healing in Ulcerative Colitis

2020 ◽  
Vol 14 (9) ◽  
pp. 1282-1289 ◽  
Author(s):  
Marietta Iacucci ◽  
Rosanna Cannatelli ◽  
Xianyong Gui ◽  
Davide Zardo ◽  
Alina Bazarova ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Roc Curves ◽  
Mucosal Healing ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
High Definition ◽  
Endoscopic Score ◽  
Virtual Chromoendoscopy ◽  
Sensitivity Specificity ◽  
A Prospective Study

Abstract Background Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological 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 [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [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 of 94.9%, specificity of 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.

scholarly journals Sa1965 DEVELOPMENT AND VALIDATION OF A NEW CLASSIFICATION FOR IN VIVO DIAGNOSIS OF DUODENAL EPITHELIAL TUMORS WITH CONFOCAL LASER ENDOMICROSCOPY

2018 ◽  
Vol 87 (6) ◽  
pp. AB268-AB269
Author(s):  
Tomomitsu Tahara ◽  
Noriyuki Horiguchi ◽  
Masaaki Okubo ◽  
Hyuga Yamada ◽  
Tomohiko Kawamura ◽  
...  
Keyword(s):  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
New Classification ◽  
Epithelial Tumors ◽  
In Vivo Diagnosis ◽  
Development And Validation

P077 A NEW TREATMENT APPROACH FOR INFLAMMATORY BOWEL DISEASE: INTRACOLONIC BIFIDOBACTERIUM AND XYLOGLUCAN APPLICATION

2020 ◽  
Vol 26 (Supplement_1) ◽  
pp. S35-S36
Author(s):  
Hüseyin Bozkurt
Keyword(s):  
Ulcerative Colitis ◽  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Mucosal Healing ◽  
Single Administration ◽  
Diagnostic Strategies ◽  
Bifidobacterium Animalis ◽  
Mayo Score ◽  
Before And After ◽  
Inflammatory Bowel

Abstract Background Inflammatory bowel disease (IBD) pathogenesis includes the altered gut microbiota, environmental factors, human immune responses and genetic. Reduced bifidobacteria level is associated with IBD. Xyloglucan is a plant based prebiotic oligosaccharide. Bifidobacteria level is increased in the presence of xyloglucan. In this article we aim to share the results of our cases; Ulcerative colitis (UC) patients treated by intracolonic single administration of Bifidobacterium animalis subsp. lactis and Xyloglucan combination. Methods Ten UC patients were evaluated; before and after intracolonic single administration of Bifidobacterium animalis subsp. lactis and Xyloglucan combination with colonoscopic laboratory and clinical examination. Results Age, sex, diagnosis, disease location, previous medications are summarized in Table 1. All the patients had active ulcerative colitis disease before the administration. The Mayo Score was used to assess the severity of UC. 2 cases had extensive colitis and 8 patients had left-sided colitis. After 6 weeks of the administration mucosal healing and resolution of colonic symptoms were seen. These results are summarized in Table 2. Of the 10 cases, 7 were undertaken 5-ASA +Azathiopurine and three were undertaken vedolizumab treatment. Intracolonic single Bifidobacterium animalis subsp. lactis and xyloglucan administration was found effective in the mucosal healing and resolution of colonic symptoms in ulcerative colitis patients. Conclusions Herein we reported the importance of Bifidobacterium and xylooligosaccharide combination in IBD. Colonoscopic single Bifidobacterium animalis subsp. lactis and xyloglucan administration is a new method that has no side effect and easy to apply for treatment of IBD.This application might provide enhancement of non-stimulatory status and higher biodiversity in colonic mucosa so mucosal healing may be improved rapidly. However, it would be necessary to develop diagnostic strategies in order to discriminate which patients would benefit from this strategy.

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