Spatial Evolution of Histologic and Endoscopic Healing in the Left and Right Colon in Patients With Ulcerative Colitis.
Spatial Evolution of Histologic and Endoscopic Healing in the Left and Right Colon in Patients With Ulcerative Colitis.
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DOI：
10.1016/j.cgh.2021.02.007
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发表时间：
2022-04
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--
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尽管组织学缓解作为溃疡性结肠炎（UC）的治疗目标越来越受到关注，但左结肠组织学检查结果在检测全结肠组织学缓解方面的准确性尚不清楚。在一项对接受靶向治疗干预的内镜下活动性全结肠炎患者进行的回顾性队列研究中，我们评价了结肠镜检查左侧（脾曲远端）组织学和内镜检查结果检测结肠其他部位组织学和内镜愈合的诊断准确性。在86例中重度活动性全结肠炎患者中，在靶向治疗干预期间接受了两次连续结肠镜检查，分别有38%和51%的患者实现了组织学和内镜缓解。在随访结肠镜检查中观察到左右结肠的组织学结果基本一致（kappa，0.67; 95%置信区间（CI），0.51-0.83）。左结肠的组织学和内镜检查结果显示，在检测全结肠组织学缓解方面具有极好的准确性（曲线下面积（AUC），0.96 [95% CI，0.93-1.0];错分率5.9%），组织学正常化（AUC，1.0，0%）、内镜改善（AUC，0.95 [0.96-1.0]，3.5%）和内镜缓解（AUC，0.98 [0.96-1.00]，5.8%）。在接受靶向治疗干预的活动性全结肠炎患者中，结肠镜检查左结肠的组织学和内镜检查结果对于检测全结肠组织学缓解、组织学正常化、内镜改善和内镜缓解具有极好的准确性。软式乙状结肠镜可用于监测全结肠炎患者的组织学和内镜活动。
Despite increasing interest in histologic remission as a treatment target in ulcerative colitis (UC), the accuracy of histologic findings in left colon in detecting pancolonic histologic remission is unknown. In a retrospective cohort study of patients with endoscopically active pancolitis undergoing treat-to-target interventions, we evaluated the diagnostic accuracy of left-sided (distal to splenic flexure) histologic and endoscopic findings on colonoscopy for detecting histologic and endoscopic healing elsewhere in the colon. Of 86 patients with moderate to severely active pancolitis who underwent two consecutive colonoscopies during treat-to-target interventions, 38% and 51% achieved histologic and endoscopic remission, respectively. Substantial agreement (kappa, 0.67; 95% confidence interval (CI), 0.51–0.83) was observed in histologic findings between left and right colon on follow-up colonoscopy. Histologic, and endoscopic, findings in left colon showed excellent accuracy in detecting pancolonic histologic remission (area under the curve (AUC), 0.96 [95% CI, 0.93–1.0]; misclassification rate, 5.9%), histologic normalization (AUC, 1.0, 0%), endoscopic improvement (AUC, 0.95 [0.96–1.0], 3.5%) and endoscopic remission (AUC, 0.98 [0.96–1.00], 5.8%), respectively. In patients with active pancolitis undergoing treat-to-target interventions, histologic and endoscopic findings in the left colon on colonoscopy have excellent accuracy for detecting pancolonic histologic remission, histologic normalization, endoscopic improvement, and endoscopic remission. Flexible sigmoidoscopy may suffice for monitoring histologic and endoscopic activity in patients with pancolitis.
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影响因子：
7.6
作者：
Jangi S;Yoon H;Dulai PS;Valasek M;Boland BS;Jairath V;Feagan BG;Sandborn WJ;Singh S
通讯作者：
Singh S
影响因子：
24.5
作者：
Marchal-Bressenot, Aude;Salleron, Julia;Peyrin-Biroulet, Laurent
通讯作者：
Peyrin-Biroulet, Laurent
影响因子：
4.9
作者：
Mutinga, ML;Odze, RD;Farraye, FA
通讯作者：
Farraye, FA
影响因子：
8
作者：
Christensen, Britt;Hanauer, Stephen B.;Rubin, David T.
通讯作者：
Rubin, David T.
影响因子：
1.9
作者：
LANDIS, JR;KOCH, GG
通讯作者：
KOCH, GG