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P263. Clinical impact of magnifying chromoendoscopy on assessment of mucosal healing and prediction of disease relapse in quiescent ulcerative colitis

M. Matsuura1, H. Nakase2, T. Yoshino1, T. Chiba1, 1Kyoto University Hospital, Department of Gastroenterology and Hepatology, Kyoto, Japan, 2Kyoto University Hospital, Division of Endoscopic Medicine, Kyoto, Japan

Background

Mucosal healing (MH) has emerged as an important treatment goal in ulcerative colitis (UC). Several previous studies showed that achievement of mucosal healing is associated with medium- and long-term clinical outcome. However, there is no validated definition of MH. The aim of this study is to examine the usefulness of magnifying colonoscopy for evaluation of MH in UC.

Methods

We reviewed magnifying colonoscopic findings in 30 patients with quiescent UC who achieved complete MH (Endoscopic subscore of Mayo 0) by conventional colonoscopy. All patients performed magnifying observation using spraying with 0.1% indigo carmine dye solution after conventional colonoscopy. According to the fine network and cryptal pit patterns of colonic mucosa, we classified magnifying colonoscopic findings into four types (magnifying subscore 0–3); 0, the surface structures similar to normal colonic mucosa; 1, the disarray of fine network or cryptal pit patterns were observed; 2, the abnormal surface structures, such as fusion or disruption of fine network patterns and loss of cryptal pit patterns were observed; 3, the fine network or cryptal pit patterns were completely disappeared. We examined: (1) the proportion of patients without clinical relapse (magnifying subscore 0 or 1 group vs subscore 2 or 3 group); (2) the patients' characteristics (age, gender, disease phenotype, extent disease, and medications) between our magnifying colonoscopic classifications. Disease activity was evaluated using a clinical activity index of Rachmilewitz (CAI), and clinical remission was defined as CAI score of 4 or more.

Results

The distribution of magnifying colonoscopic findings was as follows; 10 (subscore 0), 9 (subscore 1), 8 (subscore 2) and 3 (subscore 3). The proportion of patients with relapse-free in magnifying subscore 0 or 1 group was significantly higher than that in magnifying subscore 2 or 3 group (89.5% vs 36.4% at 12 months after magnifying chromoendoscopy, log-rank test p < 0.01). The patients in magnifying subscore 2 or 3 group significantly received more cumulative dose of prednisolone compared with those in magnifying subscore 0 or 1 group (485.0±104.9 vs 77.6±47.4 mg/month), however, there was no significant correlation between magnifying subscore and other clinical parameters.

Conclusion

Magnifying colonoscopy can provide additional benefits for evaluation of MH by conventional colonoscopy in quiescent UC.