More promising news for real-time histology during endoscopy

SAN DIEGO – In patients with ulcerative colitis, real-time histology via probe confocal laser endomicroscopy (pCLE) produces mucosal scores that reflect the findings of other approaches, a new study finds.

“The pCLE score is a paradigm which may be translated to modern high-definition endoscopes and new scoring systems,” said the study’s lead author Dr. Marietta Iacucci, clinical associate professor of medicine with the division of gastroenterology at the University of Calgary (Alta.). “We need to assess the inflammation in inflammatory bowel disease with more accurate scoring to determine subtle inflammation changes which relate to risk of flares and dysplastic changes.”

At issue: Endoscopic assessment of mucosal inflammation and healing. “This is the most important component of determining the severity of ulcerative colitis at clinical trial and in clinical practice,” Dr. Iacucci said. “Now, new endoscopy equipment, high-resolution imaging, electronic chromoendoscopy, and magnification with optical enhancement are changing the landscape and providing fine details of the mucosa, both in mucosal architecture and vascular architecture.”

The study examines real-time histology via pCLE, which “permits a slender probe to obtain real-time histology-like images after injection of fluorescein dye,” she said. “We aimed to determine whether there is an agreement between pCLE score and other new scoring systems such as the recently described iSCAN score, Mayo endoscopic subscore, and histologic scores.”

The researchers analyzed 90 patients (82 with ulcerative colitis and 8 controls, 54 male, median age 47 years, 19-79 years) assessed via iSCAN virtual chromoendoscopy and pCLE.

The pCLE scores were significantly correlated with several other measures such as Mayo endoscopy subscore (rs = 0.79; 95% confidence iinterval, 0.7-0.85; P less than .001) and the overall mucosal and vascular pattern iSCAN endoscopic score (rs = 0.83; 95% CI, 0.76-0.88; P = .0001).

The Harpaz histology score was also significantly correlated with pCLE (rs = 0.59; 95% CI, 0.44-0.71; P = .0001). In addition, pCLE features of leakage of fluorescein (rs = 0.75; 95% CI, 0.64-0.87; P less than .00001), vascular architecture (rs = 0.77; 95% CI, 0.67-0.84; P less than .0001) and blood flow (rs = 0.80; 95% CI, 0.71-0.86; P less than .00001) reflected the endoscopic iSCAN vascular pattern.

The sensitivity of pCLE to detect histologic inflammation was 92.6%.

In a discussion at the annual Digestive Disease Week, an attendee asked Dr. Iacucci if pCLE could replace endoscopy with biopsy. “I think it will add value when we have to decide if we need to continue biological therapy, which is very expensive,” she said.

She also noted that an analysis takes her only 5-10 minutes. “When we look at it from a cost-benefit perspective,” she said, “it’s another tool, especially when you need to make decisions.”

SAN DIEGO – In patients with ulcerative colitis, real-time histology via probe confocal laser endomicroscopy (pCLE) produces mucosal scores that reflect the findings of other approaches, a new study finds.

“The pCLE score is a paradigm which may be translated to modern high-definition endoscopes and new scoring systems,” said the study’s lead author Dr. Marietta Iacucci, clinical associate professor of medicine with the division of gastroenterology at the University of Calgary (Alta.). “We need to assess the inflammation in inflammatory bowel disease with more accurate scoring to determine subtle inflammation changes which relate to risk of flares and dysplastic changes.”

At issue: Endoscopic assessment of mucosal inflammation and healing. “This is the most important component of determining the severity of ulcerative colitis at clinical trial and in clinical practice,” Dr. Iacucci said. “Now, new endoscopy equipment, high-resolution imaging, electronic chromoendoscopy, and magnification with optical enhancement are changing the landscape and providing fine details of the mucosa, both in mucosal architecture and vascular architecture.”

The study examines real-time histology via pCLE, which “permits a slender probe to obtain real-time histology-like images after injection of fluorescein dye,” she said. “We aimed to determine whether there is an agreement between pCLE score and other new scoring systems such as the recently described iSCAN score, Mayo endoscopic subscore, and histologic scores.”

The researchers analyzed 90 patients (82 with ulcerative colitis and 8 controls, 54 male, median age 47 years, 19-79 years) assessed via iSCAN virtual chromoendoscopy and pCLE.

The pCLE scores were significantly correlated with several other measures such as Mayo endoscopy subscore (rs = 0.79; 95% confidence iinterval, 0.7-0.85; P less than .001) and the overall mucosal and vascular pattern iSCAN endoscopic score (rs = 0.83; 95% CI, 0.76-0.88; P = .0001).

The Harpaz histology score was also significantly correlated with pCLE (rs = 0.59; 95% CI, 0.44-0.71; P = .0001). In addition, pCLE features of leakage of fluorescein (rs = 0.75; 95% CI, 0.64-0.87; P less than .00001), vascular architecture (rs = 0.77; 95% CI, 0.67-0.84; P less than .0001) and blood flow (rs = 0.80; 95% CI, 0.71-0.86; P less than .00001) reflected the endoscopic iSCAN vascular pattern.

The sensitivity of pCLE to detect histologic inflammation was 92.6%.

In a discussion at the annual Digestive Disease Week, an attendee asked Dr. Iacucci if pCLE could replace endoscopy with biopsy. “I think it will add value when we have to decide if we need to continue biological therapy, which is very expensive,” she said.

She also noted that an analysis takes her only 5-10 minutes. “When we look at it from a cost-benefit perspective,” she said, “it’s another tool, especially when you need to make decisions.”

SAN DIEGO – In patients with ulcerative colitis, real-time histology via probe confocal laser endomicroscopy (pCLE) produces mucosal scores that reflect the findings of other approaches, a new study finds.

“The pCLE score is a paradigm which may be translated to modern high-definition endoscopes and new scoring systems,” said the study’s lead author Dr. Marietta Iacucci, clinical associate professor of medicine with the division of gastroenterology at the University of Calgary (Alta.). “We need to assess the inflammation in inflammatory bowel disease with more accurate scoring to determine subtle inflammation changes which relate to risk of flares and dysplastic changes.”

At issue: Endoscopic assessment of mucosal inflammation and healing. “This is the most important component of determining the severity of ulcerative colitis at clinical trial and in clinical practice,” Dr. Iacucci said. “Now, new endoscopy equipment, high-resolution imaging, electronic chromoendoscopy, and magnification with optical enhancement are changing the landscape and providing fine details of the mucosa, both in mucosal architecture and vascular architecture.”

The study examines real-time histology via pCLE, which “permits a slender probe to obtain real-time histology-like images after injection of fluorescein dye,” she said. “We aimed to determine whether there is an agreement between pCLE score and other new scoring systems such as the recently described iSCAN score, Mayo endoscopic subscore, and histologic scores.”

The researchers analyzed 90 patients (82 with ulcerative colitis and 8 controls, 54 male, median age 47 years, 19-79 years) assessed via iSCAN virtual chromoendoscopy and pCLE.

The pCLE scores were significantly correlated with several other measures such as Mayo endoscopy subscore (rs = 0.79; 95% confidence iinterval, 0.7-0.85; P less than .001) and the overall mucosal and vascular pattern iSCAN endoscopic score (rs = 0.83; 95% CI, 0.76-0.88; P = .0001).

The Harpaz histology score was also significantly correlated with pCLE (rs = 0.59; 95% CI, 0.44-0.71; P = .0001). In addition, pCLE features of leakage of fluorescein (rs = 0.75; 95% CI, 0.64-0.87; P less than .00001), vascular architecture (rs = 0.77; 95% CI, 0.67-0.84; P less than .0001) and blood flow (rs = 0.80; 95% CI, 0.71-0.86; P less than .00001) reflected the endoscopic iSCAN vascular pattern.

The sensitivity of pCLE to detect histologic inflammation was 92.6%.

In a discussion at the annual Digestive Disease Week, an attendee asked Dr. Iacucci if pCLE could replace endoscopy with biopsy. “I think it will add value when we have to decide if we need to continue biological therapy, which is very expensive,” she said.

She also noted that an analysis takes her only 5-10 minutes. “When we look at it from a cost-benefit perspective,” she said, “it’s another tool, especially when you need to make decisions.”