An international multicenter real-life prospective study of electronic chromoendoscopy score PICaSSO in ulcerative colitis

Marietta Iacucci, Samuel CL Smith, Alina Bazarova, Uday Shivaji, Pradeep Bhandari, Rosanna Cannatelli, Marco Daperno, Jose Ferraz, Martin Goetz, Xianyong Gui, Bu Hayee, Gert De Hertogh, Mark Lazarev, Jim Li, Olga Nardone, Adolfo Parra-Blanco, Luca Pastorelli, Remo Panaccione, Vincenzo Occhipinti, Timo RathGian Eugenio Tontini, Michael Vieth, Vincenzo Villanacci, Davide Zardo , Raf Bisschops, Ralf Kiesslich, Subrata Ghosh

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2 Citations (Scopus)
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Background & Aims

Endoscopic and histologic remission are important goals in the treatment of ulcerative colitis (UC). We investigated the correlation of the recently developed Paddington International Virtual ChromoendoScopy ScOre (PICaSSO) and other established endoscopic scores against multiple histological indices and prospectively assessed outcomes.



In this prospective multicenter international study, inflammatory activity was assessed with high-definition and virtual chromoendoscopy in the rectum and sigmoid using the Mayo Endoscopic Score (MES), UC Endoscopic Index of Severity (UCEIS), and PICaSSO. Targeted biopsies were taken for assessment using Robarts Histological Index (RHI), Nancy Histological index (NHI), ECAP (Extent, Chronicity, Activity, Plus score), Geboes, and Villanacci. Follow-up data were obtained at 6 and 12 months after colonoscopy.



A total of 307 patients were recruited. There was strong correlation between PICaSSO and histology scores, significantly superior to correlation coefficients of MES and UCEIS with histology scores. A PICaSSO score of ≤3 detected histologic remission by RHI (≤3 + absence of neutrophils) with area under the receiver operating characteristic curve (AUROC) 0.90 (95% confidence interval [CI] 0.86–0.94) and NHI (≤1) AUROC 0.82 (95% CI 0.77–0.87). The interobserver agreement for PICaSSO was 0.88 (95% CI 0.83–0.92). At 6- and 12-months follow-up, PICaSSO score ≤3 predicted better outcomes than PICaSSO >3 (hazard ratio [HR] 0.19 [0.11–0.33] and 0.22 [0.13–0.34], respectively),} as well as PICaSSO 4–8 (HR 0.25 [0.12–0.53] and 0.22 (0.12–0.39), respectively) and similar to histologic remission.



In this first real-life multicenter study, the PICaSSO score correlated strongly with multiple histological indices. Furthermore, PICaSSO score predicted specified clinical outcomes at 6 and 12 months, similar to histology. Thus, PICaSSO can be a useful endoscopic tool in the therapeutic management of UC.

Original languageEnglish
Early online date18 Dec 2020
Publication statusE-pub ahead of print - 18 Dec 2020

Bibliographical note

Funding: Marietta Iacucci and Subrata Ghosh are part-funded by the NIHR Birmingham Biomedical Research Centre The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.


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