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World J Gastroenterol. Oct 7, 2026; 32(37): 119611
Published online Oct 7, 2026. doi: 10.3748/wjg.119611
Endocytoscopy for histological evaluation of inflammation in ulcerative colitis
Miao Li, Xiao-Ying Lou, Zhong-Cheng Liu, Bo Peng, Yan Huang, Qin Guo
Miao Li, Qin Guo, Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Miao Li, Xiao-Ying Lou, Zhong-Cheng Liu, Bo Peng, Yan Huang, Qin Guo, Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Miao Li, Xiao-Ying Lou, Zhong-Cheng Liu, Bo Peng, Yan Huang, Qin Guo, Guangdong Provincial Clinical Research Center for Digestive Diseases, Guangzhou 510655, Guangdong Province, China
Xiao-Ying Lou, Yan Huang, Department of Pathology, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Zhong-Cheng Liu, Bo Peng, Qin Guo, Department of Small Bowel Endoscopy, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou 510655, Guangdong Province, China
Co-first authors: Miao Li and Xiao-Ying Lou.
Co-corresponding authors: Yan Huang and Qin Guo.
Author contributions: Li M and Lou XY conceptualized the study, performed data curation, they contributed equally to this article, they are the co-first authors of this manuscript; Li M drafted the original manuscript; Lou X revised and edited the manuscript; Liu ZC and Peng B assisted with data curation and manuscript revision; Huang Y and Guo Q conducted data curation, supervised the research process and revised the manuscript they contributed equally to this article, they are the co-corresponding authors of this manuscript; Li M, Lou XY, and Huang Y completed formal analysis; and all authors take accountability for all aspects of the work and have approved the final version for publication.
Supported by National Key Research & Development Program of China, No. 2023YFC2507300; the Program of Guangdong Provincial Clinical Research Center for Digestive Diseases, No. 2020B1111170004; the National Natural Science Foundation of China, No. 82302334; Guangdong Provincial Health Commission Appropriate Technology Promotion Project, No. 201905242108259876; and the Sixth Affiliated Hospital of Sun Yat-sen University Clinical Research “1010” Program, No. 1010CG(2023)-02.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Sixth Affiliated Hospital of Sun Yat-sen University, approval No. E2025172.
Informed consent statement: All patients included in this study signed an informed consent form.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Corresponding author: Qin Guo, MD, Department of Gastroenterology, The Sixth Affiliated Hospital, Sun Yat-sen University, No. 26 Yuancun Erheng Road, Tianhe District, Guangzhou 510655, Guangdong Province, China.
guoq83@mail.sysu.edu.cn
Received: February 2, 2026
Revised: March 13, 2026
Accepted: May 9, 2026
Published online: October 7, 2026
Processing time: 212 Days and 15.5 Hours
BACKGROUND
Histological remission in ulcerative colitis (UC) can be assessed traditionally by microscopic examination of endoscopic biopsies. Recently, advanced endocytoscopy has been increasingly used for real-time evaluation of the colonic mucosa in UC.
AIM
To develop a novel scoring system based on endocytoscopic (ECS) images to ascertain the function of ECS score (ECSS) in the evaluation of endoscopic remission and histological remission among patients with UC.
METHODS
In this retrospective study, ECS images were analyzed and ECSS was developed to differentiate between active and inactive UC. ECSS was correlated with the Mayo endoscopic score and the pathological Geboes score (GS).
RESULTS
A total of 72 UC patients were included in the study. With reference to the GS, a value of 14.5 on the newly developed ECSS served as the cut-off value. Patients were divided into two groups based on this cut-off value: Active or inactive UC. The ECSS showed a strong correlation with the more stringent pathological GS (< 2B for inflammatory inactive) (kappa value: 0.838) and differences from the pathological GS (< 3.2 for inflammatory inactive). In contrast, white light endoscopy showed differences from the more stringent pathological GS (< 2B for inflammation) and only general agreement with the relatively low standard GS (< 3.2 for inflammation) (kappa value: 0.496). There was high consistency in the ECSS among endoscopists (intraclass correlation coefficient value of 0.790).
CONCLUSION
The endocytoscopy technique has high interobserver consistency and good reproducibility. The newly developed ECSS system has a strong correlation with the histological changes associated with patients with UC. It can be used to stratify patients based on inflammatory activity and mucosal healing without biopsies, and warrants further investigation.
Core Tip: Histological remission in ulcerative colitis (UC) can be assessed traditionally by microscopic examination of endoscopic biopsies. Recently, advanced endocytoscopy has been increasingly used for real-time evaluation of the colonic mucosa in UC. The current study developed a novel scoring system based on endocytoscopic images called as endocytoscopic score (ECSS) to evaluate endoscopic and histological remission in UC. ECSS showed strong correlation with histological changes. ECSS has high interobserver consistency and good reproducibility. ECSS can be used to stratify patients based on inflammatory activity and mucosal healing without biopsies, providing a new direction for real-time non-invasive assessment of UC.
