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P295 The Ulcerative Colitis Endoscopic Index of Severity is useful to predict medium- to long-term prognosis in ulcerative colitis patients with clinical remission

M. Arai*1, M. Naganuma1, S. Sugimoto1, H. Kiyohara1, K. Ohno1, M. Mutaguchi1, K. Mori1, K. Nanki1, S. Mizuno1, R. Bessho1, Y. Nakazato2, N. Inoue3, H. Ogata2, Y. Iwao2, T. Kanai1

1Keio University School of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokyo, Japan, 2Keio University School of Medicine, Centre for Diagnostic and Therapeutic Endoscopy, Tokyo, Japan, 3Keio University School of Medicine, Centre for Preventive Medicine, Tokyo, Japan

Background

Mucosal healing is an important concept in the management of ulcerative colitis (UC). The Ulcerative Colitis Endoscopic Index of Severity is a newly developed endoscopic scoring system. Although the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) is a validated scoring system, there has been no study to evaluate the usefulness of the UCEIS in clinical settings. In this study, we aimed to assess the correlation between the UCEIS and existing scores and to predict clinical prognosis of UC patients with clinical remission (CR) using the UCEIS.

Methods

This was a retrospective cohort study. We performed colonoscopy on UC patients at Keio University Hospital between April 2012 and March 2013. We reviewed clinical characteristics and endoscopic scores at the time of the colonoscopy and checked the clinical remission rate in the patients with CR until September 2015. UCEIS and Mayo endoscopic scores were assessed by the single operator at the procedure of colonoscopy. CR and relapse were defined as a partial Mayo (pMayo) score ≤ 1 and pMayo score ≥ 3, Lichtiger score ≥ 5, alteration, or addition of medical treatments, respectively.

Results

A colonoscopy was performed on a total of 215 UC patients within the aforementioned period, and 117 of those maintained CR. Although the correlation between the UCEIS score and the Mayo endoscopic score was strong (r = 0.940), the Lichtiger score (r = 0.611) and C-reactive protein (CRP) (r = 0.397) had moderate to poor correlation with the UCEIS score. In patients with CR, 87.6% maintained CR at 1 year and 75.2% at 2 years. During the follow-up period, the lower UCEIS score showed a higher rate of CR, and patients with the UCEIS score of 0–1 had a significantly higher rate of CR than those with the UCEIS score of 2 or more (p<0.001) did. The follow-up period duration had a range of 0–41 months, with a mean duration of 22.7 months. Absence of bleeding and mucosal damage on colonoscopy were associated with maintaining CR. Amongst patients with Mayo endoscopic score of 0, those with the UCEIS score of 0 had a higher rate (95%) of CR compared with those with the UCEIS score of 1 (77.8%) or 2 (75%).

Conclusion

The UCEIS is useful to predict a medium- to long-term outcome of UC patients with CR. Mucosal healing may be defined with a UCEIS score of ≤ 1. Absence of bleeding and mucosal damage on colonoscopy are associated with maintaining CR.