Di Vincenzo Federica, Quintero Maria A, Serigado Joao M, Koru-Sengul Tulay, Killian Rose Marie, Poveda Julio, England Jonathan, Damas Oriana, Kerman David, Deshpande Amar, Abreu Maria T
Division of Gastroenterology, Department of Medicine, University of Miami - Leonard Miller School of Medicine, Miami, FL, USA.
Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy.
J Crohns Colitis. 2025 Jun 4;19(6). doi: 10.1093/ecco-jcc/jjae141.
The advantages of endoscopic vs histologic assessments of inflammation in inflammatory bowel disease remain unclear. We compared endoscopic and histologic inflammation in a prospective cohort. Furthermore, in patients with discordant findings, we compared the ability of endoscopy vs histology to predict disease course.
Ulcerative colitis (UC) or Crohn's disease (CD) patients underwent routine colonoscopies with intestinal biopsies, which included ratings of inflammation severity. Tetrachoric correlation analysis between the endoscopic and histologic inflammation ratings was performed. In postsurgical CD patients, major adverse outcomes (MAOs) were recorded.
The analysis included 749 patients (60.2% CD patients), with 2807 biopsied segments. We found high concordance between endoscopist and pathologist inflammation ratings (0.84, 95% confidence interval, 0.81-0.87, p < 0.0001). Only 12.5% of biopsied segments exhibited microscopic inflammation without endoscopic inflammation. Neo-terminal ileum (neo-TI) biopsies exhibited the highest discordance; UC colonic biopsies had the highest concordance. Postsurgical CD patients who completed the 48-month follow-up (n = 138) were included in the survival analysis. The probability of MAO-free survival was significantly higher in patients with a Rutgeerts score of i0 at baseline than in those with higher scores. Microscopic inflammation in the neo-TI did not predict a higher risk of MAOs (p = 1.00).
In a real-world setting, endoscopic inflammation predicted histologic inflammation with high accuracy. In patients with a Rutgeerts score of i0, microscopic inflammation in neo-TI biopsies did not predict more aggressive disease behavior over the next 4 years. These results have implications for the design of clinical trials, suggesting the use of endoscopic healing as an endpoint.
在炎症性肠病中，内镜评估炎症与组织学评估炎症的优势尚不清楚。我们在一个前瞻性队列中比较了内镜下炎症与组织学炎症。此外，在检查结果不一致的患者中，我们比较了内镜检查与组织学检查预测疾病进程的能力。
溃疡性结肠炎（UC）或克罗恩病（CD）患者接受常规结肠镜检查及肠道活检，其中包括炎症严重程度评分。对内镜下炎症评分与组织学炎症评分进行四分相关分析。记录手术后CD患者的主要不良结局（MAO）。
分析纳入749例患者（60.2%为CD患者），共2807个活检部位。我们发现内镜医师与病理学家的炎症评分具有高度一致性（0.84，95%置信区间，0.81 - 0.87，p < 0.0001）。仅12.5%的活检部位显示微观炎症但无内镜下炎症。新末端回肠（neo-TI）活检的不一致性最高；UC结肠活检的一致性最高。完成48个月随访的手术后CD患者（n = 138）纳入生存分析。基线Rutgeerts评分为i0的患者无MAO生存的概率显著高于评分较高的患者。neo-TI中的微观炎症并未预测MAO的更高风险（p = 1.00）。
在实际临床环境中，内镜下炎症能高度准确地预测组织学炎症。对于Rutgeerts评分为i0的患者，neo-TI活检中的微观炎症在未来4年并未预测更具侵袭性的疾病行为。这些结果对临床试验设计具有启示意义，提示可将内镜下愈合作为终点。
