K. Uchiyama, M. Kubota, Y. Azuma, R. Yasuda, T. Shun, T. Takagi, Y. Naito, I. Yoshito
Kyoto Prefectural University Of Medicine, Department of Molecuar Gastroenterology and Hepatology, Kyoto, Japan
Mucosal healing is important for the patients of ulcerative colitis (UC) to avoid clinical relapse and developing colitic cancer. Though Mayo endoscopic subscore (MES) has been widely used to evaluate mucosal healing of UC patients, it is not enough to predict relapse. We have reported the new endoscopic evaluation by linked colour imaging (LCI) that enhances mucosal redness and can predict relapse with more precision compared with MES1). However, the diagnosis in both MES and LCI depends on the local lesion and it has not been established the comprehensive evaluation because mucosal redness is not clearly recognised by white light image. In the present study, we examined the comprehensive evaluation of mucosal redness in the patients of UC by LCI and investigate the relation with long-term prognosis.
All examinations were carried out with an EG-L590WR endoscope and a LASEREO endoscopic system (FUJIFILM Co., Tokyo, Japan) including 47 UC patients (pan colitis type) with clinically remission (Under 4 of Lichtiger CAI score). Each part of the large intestine (ascending colon, transverse colon, descending colon, sigmoid colon and rectum) was observed with LCI and WLI (white light image), and the area of redness (regardless of strength) was evaluated. The score was marked 0, 1, 2 and 3, in case of the area of redness is 0%, <50%, 50% or higher and 100%, respectively. The score of each part was totalled (total redness score), and the relapse rate for 1 year after the endoscopy was investigated. Relapse of ulcerative colitis was defined as the need for more aggressive medication for ulcerative colitis due to aggravation or clinical symptoms, or aggravation of endoscopic findings.
The relapse ratio was 19.1% (9/47 cases). The average of total redness score by LCI was 4.02 ± 2.25 and total redness score by WLI was 3.11 ± 2.5. The average of total redness score by LCI in the patients with no relapse group was 3.94 ± 2.21, on the other hand, with relapse group was 4.33 ± 2.23 (p = 0.0354). However, total redness score measured by WLI showed no statistical difference between no relapse group and relapse (p = 0.278).
A comprehensive evaluation of mucosal redness using LCI is useful approach to predict relapse for UC patients with clinical remission.