Hepato-Gastroenterology and Digestive Endoscopy Department, Georges Pompidou European Hospital, APHP Centre-Université de Paris, Paris, France.
CHU Nantes, Institut des Maladies de l'Appareil Digestif [IMAD], University of Nantes, Nantes, France.
J Crohns Colitis. 2021 Jun 22;15(6):994-999. doi: 10.1093/ecco-jcc/jjaa255.
Histological healing may represent the ultimate therapeutic goal in ulcerative colitis [UC], but it requires biopsies. Our aim was to develop a non-invasive index able to assess histological disease activity in ulcerative colitis, using probe-based confocal laser endomicroscopy [pCLE].
One hundred patients with quiescent UC were prospectively included in five French centres. After fluorescein intravenous injection, during colonoscopy, the colorectal mucosa was analysed by white light imaging and pCLE, and then biopsied in different locations. Five endoscopists performed central reading of pCLE images blinded to clinical, endoscopic, and histological data. One expert pathologist performed a central histological reading [Nancy index: gold standard]. Univariate and multivariate analyses were performed to identify the endomicroscopic items associated with the presence of histologically active disease.
Over 1000 pCLE videos sequences performed in 100 UC patients in endoscopic remission [Mayo 0 and 1] were evaluated. We observed that vessel diameter >20 µm, dilated crypt lumen, fluorescein leakage, and irregular crypt architecture were statistically associated with histologically proven inflammation according to the Nancy index. Hence, we built a pCLE index of mucosal inflammation with overall accuracy of 79.6% and overall sensitivity and specificity of, respectively, 57.8% and 82.8%. Negative predictive value, especially when a pCLE index ≤1 was observed, was high [93.1%].
Using a robust methodology, large vessel diameter, dilated crypt lumen, fluorescein leakage,and irregular crypt architecture are reliable endomicroscopic items defining the ENHANCE index for real-time assessment of histological disease activity in UC.
组织学愈合可能代表溃疡性结肠炎[UC]的最终治疗目标，但需要进行活检。我们的目的是开发一种非侵入性指数，能够使用基于探头的共聚焦激光内窥镜检查[pCLE]评估溃疡性结肠炎的组织学疾病活动。
100 例处于缓解期的 UC 患者前瞻性纳入五个法国中心。静脉注射荧光素后，在结肠镜检查期间，白光成像和 pCLE 分析结直肠黏膜，并在不同部位进行活检。五位内镜医生对 pCLE 图像进行中央阅片，阅片时不了解临床、内镜和组织学数据。一位专家病理学家进行中央组织学阅片[南希指数：金标准]。进行单变量和多变量分析，以确定与组织学活动性疾病相关的内窥镜项目。
在 100 例处于内镜缓解期[Mayo 0 和 1]的 UC 患者中进行了超过 1000 次 pCLE 视频序列评估。我们观察到，血管直径>20µm、扩张的隐窝腔、荧光素渗漏和不规则隐窝结构与根据南希指数证实的炎症具有统计学相关性。因此，我们构建了一个 pCLE 黏膜炎症指数，总体准确性为 79.6%，总体敏感性和特异性分别为 57.8%和 82.8%。阴性预测值，尤其是当观察到 pCLE 指数≤1 时，较高[93.1%]。
使用稳健的方法，大血管直径、扩张的隐窝腔、荧光素渗漏和不规则隐窝结构是可靠的内窥镜项目，定义了用于实时评估 UC 组织学疾病活动的 ENHANCE 指数。
