Ulcerative colitis (UC), one of the most common forms of chronic inflammatory bowel disease, is characterized by exacerbations and remissions. Even when conventional colonoscopy suggests remission and a normal mucosal finding, microscopic or histological abnormalities may persist, and relapse may be imminent. Confocal microendoscopy allows histological diagnosis during the endoscopic examination. High-resolution video-magnifying colonoscopy with chromoscopy enables the observation of colorectal mucosal pit patterns and prediction of the probability of subsequent disease relapse in patients in remission. Endoscopic ultrasonography provides an immediate and accurate evaluation of the health status of the colonic wall without the need to wait for histological results and provides an indication of the efficacy of treatment. These novel endoscopic techniques are useful for the evaluation of disease activity and the efficacy of treatment in patients with UC and the prediction of relapse.
Ulcerative colitis (UC) is a chronic inflammatory bowel disorder which shows evidence of activation of the immune system of the colorectum, with exacerbations and remissions [
Here, we discuss confocal endomicroscopy, a novel endoscopy technique which is predictive of the efficacy of therapies in patients with UC, endoscopic factors in magnifying colonoscopy that may predict the probability of subsequent disease relapse in UC patients in remission, and the usefulness of EUS as a diagnostic technique to assess disease status. We also reconsider the value of endoscopy in the treatment of patients with UC.
Definitive diagnosis using conventional endoscopy requires the histologic examination of a targeted biopsy, but this can take a number of days and carries the risk of bleeding. The ability to make a definitive diagnosis during endoscopy without biopsy would be useful. Confocal endomicroscopy, a recently developed method which provides high-magnification images of the gastrointestinal epithelium [
Conventional transverse section of normal (a) and inflamed mucosa (c) and confocal image of normal (b) and inflamed mucosa (d). The confocal image correlates well with the histologic image.
Various attempts have been made over many years to observe the magnified features of the gastrointestinal mucosa by stereomicroscopy of resected specimens. In their 1980 stereomicroscopy study of biopsy specimens from the rectal mucosa of UC patients, Poulsen et al. [
We performed magnifying colonoscopy (MCS) in 113 patients with ulcerative colitis in remission [
Grading of pit structures in the colorectal mucosa of patients with inactive UC. MCS grade 1: pits small, round, and regularly arranged (a). MCS grade 2: pits rather large, oval, and somewhat irregular in arrangement (b). MCS grade 3: pits of various shapes and sizes and irregularly arranged (c). MCS grade 4: dispersed pits varying in morphology associated with the presence of small erosions (d).
Recent studies [
In acute exacerbation of UC, histological findings show diffuse infiltration of neutrophils with accumulation inside and around the crypt epithelium of the affected mucosa [
Evaluation of thickness of the mucosal layer using an ultrasonic catheter probe at the Rs portion. Thickness of the mucosal layer in this UC patient is 1.2 mm.
In this paper, we evaluated the potential application of three new endoscopic techniques, confocal endomicroscopy, magnifying colonoscopy, and EUS, in UC patients. These techniques highlight the frequent discrepancy between macroscopic and microscopic findings in UC. Early reports that these imaging modalities may play an important role in the assessment and medical management of UC patients are encouraging. However, the presence of variability among endoscopists in interpreting these specialized images should be kept in mind as most reports have not considered this important point. When we consider the application of these novel techniques to Crohn's disease (CD) patients, diagnostic observation of the magnified features of the gastrointestinal mucosa may not be particularly useful, because CD is a transmural disease. However, EUS in CD patients is useful in the assessment of perianal lesions [