Assessment of endoscopic healing by using advanced technologies reflects histologic healing in ulcerative colitis

Marietta Iacucci, Subrata Ghosh, Rosanna Cannatelli, Xianyong Sean Gui, Alina Bazarova, Davide Zardo , Georgios Gkoutos, Brendan Cord Lethebe, Gilaad G. Kaplan, Remo Panaccione, Ralf Kiesslich, Subrata Ghosh

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


Background: Several studies have reported that ulcerative colitis [UC] patients with endoscopic mucosal healing may still have histological inflammation. We investigated the relationship between mucosal healing defined by modified PICaSSO [Paddington International Virtual ChromoendoScopy ScOre], Mayo Endoscopic Score [MES] and probe-based confocal laser endomicroscopy [pCLE] with histological indices in UC.

Methods: A prospective study enrolling 82 UC patients [male 66%] was conducted. High-definition colonoscopy was performed to evaluate the activity of the disease with MES assessed with High-Definition MES [HD-MES] and modified PICaSSO and targeted biopsies were taken; pCLE was then performed. Receiver operating characteristic [ROC] curves were plotted to determine the best thresholds for modified PICaSSO and pCLE scores that predicted histological healing according to the Robarts Histopathology Index [RHI] and ECAP ‘Extension, Chronicity, Activity, Plus’ histology score.

Results: A modified PICaSSO of ≤ 4 predicted histological healing at RHI ≤ 3, with sensitivity, specificity, accuracy and area under the ROC curve [AUROC] of 89.8%, 95.7%, 91.5% and 95.9% respectively. The sensitivity, specificity, accuracy and AUROC of HD-MES to predict histological healing by RHI were 81.4%, 95.7%, 85.4% and 92.1%, respectively. A pCLE ≤ 10 predicted histological healing with sensitivity of 94.9%, specificity of 91.3%, accuracy of 93.9% and AUROC of 96.5%. An ECAP of ≤ 10 was predicted by modified PICaSSO ≤ 4 with accuracy of 91.5% and AUROC of 95.9%.

Conclusion: Histological healing by RHI and ECAP is accurately predicted by HD-MES and modified virtual electronic chromoendoscopy PICaSSO, endoscopic score; and the use of pCLE did not improve the accuracy any further.
Original languageEnglish
Pages (from-to)1282-1289
JournalJournal of Crohn's & Colitis
Issue number9
Publication statusE-pub ahead of print - 23 Mar 2020


  • Mucosal healing
  • Probe-based confocal laser endomicroscopy
  • Robarts Histological Index, virtual chromoendoscopy, ECAP
  • Ulcerative colitis

ASJC Scopus subject areas

  • Gastroenterology


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