Use of confocal laser endomicroscopy to predict relapse of ulcerative colitis

BMC Gastroenterology

Yan-Qing Li²  Xiang-Jun Xie¹  Zhen Li²  Rui Ji²  Jun Liu²  Chang-Qing Li² 

[1] Department of Gastroenterology, Qingdao Municipal Hospital, Qingdao, China;Department of Gastroenterology, Laboratory of Translational Gastroenterology, Shandong University Qilu Hospital, No. 107, Wenhuaxi Road, Jinan, Shandong 250012, China

关键词: CLE;    UC;    Confocal laser endomicroscopy;    Relapse;    Ulcerative colitis;   

Others  :  855675
DOI  :  10.1186/1471-230X-14-45

 received in 2013-05-22, accepted in 2014-02-24,  发布年份 2014

【 摘 要 】

Background

Assessment of inflammatory activity in patients with ulcerative colitis (UC) is crucial to the prediction of relapse. Confocal laser endomicroscopy (CLE) is an accurate tool for assessing inflammatory activity in UC patients. This study aimed to evaluate whether CLE could be used to predict UC relapse reliably.

Methods

In total, forty-three patients with documented UC were analyzed in this study. Patients identified as having obvious active inflammation by conventional colonoscopy were excluded. The mucosa of each patient’s sigmoid colon and rectum was assessed by CLE before targeted biopsies were taken. The patients were then followed up for at least 12 months to evaluate relapse according to the Simple Clinical Colitis Activity Index. The correlation between CLE classification and UC relapse was evaluated.

Results

Seventeen of 20 patients with histologically confirmed normal or chronic inflammation were diagnosed as having non-active inflammation by real-time CLE and 22 of 23 patients with histologically confirmed acute inflammation were diagnosed as having active inflammation by CLE. The sensitivity, specificity, and accuracy of CLE in real-time diagnosis of active inflammation were 95.7%, 85%, and 90.7%, respectively. The agreement between CLE and conventional histology was excellent (kappa value = 0.812). Two of 18 (11.1%) patients who were classified as having non-active inflammation by CLE relapsed, while 16 of 25 (64%) patients classified as having as active inflammation relapsed. The relapse rate of patients with active inflammation was significantly higher than of those with non-active inflammation (P < 0.001).

Conclusions

CLE is comparable to conventional histology in predicting relapse in patients with UC.

【 授权许可】

   
2014 Li et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Fracasso P, Assisi D, Stigliano V, Casale V: Colorectal cancer complicating ulcerative colitis: an institutional series. J Exp Clin Cancer Res 1999, 18:29-32.
• [2]Velayos FS, Terdiman JP, Walsh JM: Effect of 5-aminosalicylate use on colorectal cancer and dysplasia risk: a systematic review and metaanalysis of observational studies. Am J Gastroenterol 2005, 100:1345-1353.
• [3]Bitton A, Peppercorn MA, Antonioli DA, Niles JL, Shah S, Bousvaros A, Ransil B, Wild G, Cohen A, Edwardes MD, Stevens AC: Clinical, biological, and histologic parameters as predictors of relapse in ulcerative colitis. Gastroenterology 2001, 120:13-20.
• [4]Bessissow T, Lemmens B, Ferrante M, Bisschops R, Van Steen K, Geboes K, Van Assche G, Vermeire S, Rutgeerts P, De Hertogh G: Prognostic value of serologic and histologic markers on clinical relapse in ulcerative colitis patients with mucosal healing. Am J Gastroenterol 2012, 107:1684-1692.
• [5]Pineton de Chambrun G, Peyrin-Biroulet L, Lemann M, Colombel JF: Clinical implications of mucosal healing for the management of IBD. Nat Rev Gastroenterol Hepatol 2010, 7:15-29.
• [6]Lichtenstein GR, Rutgeerts P: Importance of mucosal healing in ulcerative colitis. Inflamm Bowel Dis 2010, 16:338-346.
• [7]Ha C, Kornbluth A: Mucosal healing in inflammatory bowel disease: where do we stand? Curr Gastroenterol Rep 2010, 12:471-478.
• [8]Daperno M, Sostegni R, Lavagna A, Crocella L, Ercole E, Rigazio C, Rocca R, Pera A: The role of endoscopic assessment in ulcerative colitis in the era of infliximab. Dig Liver Dis 2008, 40(Suppl 2):S220-S224.
• [9]Hurlstone DP, Sanders DS, McAlindon ME, Thomson M, Cross SS: High-magnification chromoscopic colonoscopy in ulcerative colitis: a valid tool for in vivo optical biopsy and assessment of disease extent. Endoscopy 2006, 38:1213-1217.
• [10]Watanabe C, Sumioka M, Hiramoto T, Noda I, Oba S, Akagi M, Kitamoto M, Yamada H, Imagawa M: Magnifying colonoscopy used to predict disease relapse in patients with quiescent ulcerative colitis. Inflamm Bowel Dis 2009, 15:1663-1669.
• [11]Kiesslich R, Goetz M, Lammersdorf K, Schneider C, Burg J, Stolte M, Vieth M, Nafe B, Galle PR, Neurath MF: Chromoscopy-guided endomicroscopy increases the diagnostic yield of intraepithelial neoplasia in ulcerative colitis. Gastroenterology 2007, 132:874-882.
• [12]Watanabe O, Ando T, Maeda O, Hasegawa M, Ishikawa D, Ishiguro K, Ohmiya N, Niwa Y, Goto H: Confocal endomicroscopy in patients with ulcerative colitis. J Gastroenterol Hepatol 2008, 23(Suppl 2):S286-S290.
• [13]Li CQ, Xie XJ, Yu T, Gu XM, Zuo XL, Zhou CJ, Huang WQ, Chen H, Li YQ: Classification of inflammation activity in ulcerative colitis by confocal laser endomicroscopy. Am J Gastroenterol 2010, 105:1391-1396.
• [14]Liu JJ, Wong K, Thiesen AL, Mah SJ, Dieleman LA, Claggett B, Saltzman JR, Fedorak RN: Increased epithelial gaps in the small intestines of patients with inflammatory bowel disease: density matters. Gastrointest Endosc 2011, 73:1174-1180.
• [15]Walmsley RS, Ayres RC, Pounder RE, Allan RN: A simple clinical colitis activity index. Gut 1998, 43:29-32.
• [16]Geboes K, Riddell R, Ost A, Jensfelt B, Persson T, Lofberg R: A reproducible grading scale for histological assessment of inflammation in ulcerative colitis. Gut 2000, 47:404-409.
• [17]Jowett SL, Seal CJ, Phillips E, Gregory W, Barton JR, Welfare MR: Defining relapse of ulcerative colitis using a symptom-based activity index. Scand J Gastroenterol 2003, 38:164-171.
• [18]Riley SA, Mani V, Goodman MJ, Dutt S, Herd ME: Microscopic activity in ulcerative colitis: what does it mean? Gut 1991, 32:174-178.
• [19]Kiesslich R, Burg J, Vieth M, Gnaendiger J, Enders M, Delaney P, Polglase A, McLaren W, Janell D, Thomas S, Nafe B, Galle PR, Neurath MF: Confocal laser endoscopy for diagnosing intraepithelial neoplasias and colorectal cancer in vivo. Gastroenterology 2004, 127:706-713.
• [20]Kiesslich R, Duckworth CA, Moussata D, Gloeckner A, Lim LG, Goetz M, Pritchard DM, Galle PR, Neurath MF, Watson AJ: Local barrier dysfunction identified by confocal laser endomicroscopy predicts relapse in inflammatory bowel disease. Gut 2012, 61:1146-1153.
• [21]Liu JJ, Madsen KL, Boulanger P, Dieleman LA, Meddings J, Fedorak RN: Mind the gaps: confocal endomicroscopy showed increased density of small bowel epithelial gaps in inflammatory bowel disease. J Clin Gastroenterol 2011, 45:240-245.