P248. Endoscopic evaluation of colonic mucosa in ulcerative colitis patients in clinical remission
O. Shchukina1, E. Kondrashina2, O. Orlov3, A. Vladimirova4, A. Botina5, E. Markova6, A. Kharitidis7, 1North-West State Medical University, Chair of Gastroenterology and Dietology, Saint-Petersburg, Russian Federation, 2North-West State University, Chair of Gastroenterology and Dietology, Saint-Petersburg, Russian Federation, 3City clinical hospital #3, Saint-Petersburg, Russian Federation, 4Irkutsk Diagnostic Center, Irkutsk, Russian Federation, 5Saint-Petersburg state medical university named after I.P. Pavlov, Saint-Petersburg, Russian Federation, 6City clinical hospital #31, Saint-Petersburg, Russian Federation, 7City Clinical Hospital #31, City Centre of IBD, Saint-Petersburg, Russian Federation
Healing of colonic mucosa in ulcerative colitis (UC) is one of the main treatment goals; however definition of mucosal healing in UC has not been properly defined yet and criteria to assess endoscopic remission of UC within currently existing indices have not been duly validated. Our study aimed at validation of endoscopic signs of colonic mucosa in UC patients in clinical remission.
14 UC patients (pts) in clinical remission have been examined over a period of 2–16 months. Every colonoscopy was video-recorded and mucosa of 3 segments (ascendum, descendum and rectum) of large intestine was assessed by 3 independent endoscopists who were blinded to study results. Presence of the following features: erythema, disturbed or absence of vascular pattern, friability, bleeding, erosions, and mucosal granulations was registered. Endoscopists #1 and #2 used criteria of ECCO (2012) to assess friability, endoscopist #3 used his own criteria.
Erythema of mucosa in ascending colon were detected in 50%, 0% (p < 0.01), and 7% (p < 0.05) recordings by endoscopists #1, #2 and #3 respectively. Endoscopist #1 found erythema of mucosa in descendum in 43% pts, while both endoscopists #2 and #3 found this feature only in 7% pts (p < 0.05). Erythema of rectal mucosa was recorded by endoscopist #1 in 79%, whereas only in 7% (p < 0.01) of cases either by specialists # 2 and #3. Interestingly, significant differences between specialists were observed in assessment of friability. Endoscopist #3 found this feature in ascendum and rectum in 29% and 64% of pts respectively, whereas neither specialist #1 nor #2 did not found it at all (p < 0.05 and p < 0.001, respectively). Friability of mucosa in descendum was also noted with significantly different rate by specialist #3 comparing with either endoscopists #1 or #2: 50% and 7% (p < 0.05) respectively. There were no significant differences between specialists in assessment of the rest endoscopic criteria.
Disturbed/absent vascular pattern, bleeding, erosions, mucosal granulations were found to be valid endoscopic findings in assessment of endoscopic remission in UC. Assessment of friability was considerably affected by personal subjectivity. Erythema of mucosa was concluded to be the least valid endoscopic criteria. Analysis of results from more number of pts is needed.