Endocytoscopy for histological evaluation of inflammation in ulcerative colitis

Table 1 Mayo endoscopic score for ulcerative colitis

Number	Characteristics
0	Normal mucosa or inactive disease
1	Mild disease: Mucosal erythema, decreased vascular pattern, mild friability
2	Moderate disease: Marked mucosal erythema, absent vascular pattern, friability, erosions
3	Severe disease: Spontaneous mucosal bleeding, mucosal ulceration

Table 2 Endoscopic scoring system

Parameter		ECSS (1 + 2 + 3)
Dyeing effect: A: Good; B: Difference
ESCC criteria		Crypt 1	Crypt 2	Crypt 3	Crypt4	Crypt 5	Crypt score (1 + 2 + 3 + 4 + 5)
Crypt orifice	Normal	-	-	-	-	-	Total
	Deformed
	Disappeared
Crypt space	Normal	-	-	-	-	-	Total
	Widened
	Lymphocytes
	Neutrophils
Ductule	Normal	-	-	-	-	-	Total
	Lymphocyte infiltration
	Neutrophil infiltration

ECSS: Endoscopic scoring.

Table 3 Geboes scoring system

Grade	Characteristics
Grade 0 architectural changes	0.0 No abnormality
	0.1 Mild abnormality
	0.2 Mild/moderate diffuse or multi-focal abnormalities
	0.3 Severe diffuse or multifocal abnormalities
Grade 1 chronic inflammatory infiltrates	1.0 No increase
	1.1 Mild but unequivocal increase
	1.2 Moderate increase
	1.3 Marked increase
Grade 2A: Eosinophils in lamina propria	2A.0 No increase
	2A.1 Mild but unequivocal increase
	2A.2 Moderate increase
	2A.3 Marked increase
Grade 2B: Neutrophils in lamina propria	2B.0 No increase
	2B.1 Mild but unequivocal increase
	2B.2 Moderate increase
	2B.3 Marked increase
Grade 3 neutrophils in epithelium	3.0 None
	3.1 < 5% crypts involved
	< 50% crypts involved
	3.3 > 50% crypts involved
Grade 4 Crypt destruction	4.0 None
	4.1 Probable: Local excess of neutrophils in part of the crypts
	4.2 Probable: Marked attenuation
	4.3 Unequivocal crypt destruction
Grade 5 Erosions and ulcerations	5.0 No erosion, ulceration or granulation tissue
	5.1 Recovering epithelium + adjacent inflammation
	5.2 Probable erosion: Focally stripped
	5.3 Unequivocal erosion
	5.4 Ulcer or granulation tissue

Table 4 Comparison of baseline characteristics between endoscopic scoring active and inactive groups, n (%)

Patient characteristics	Total (n = 72)	ECSS-active (n = 23)	ECSS-inactive (n = 49)	P value	P value (Bonferroni)
Sex
Female	36 (50.00)	11 (47.83)	25 (51.02)	0.800	-
Male	36 (50.00)	12 (52.17)	24 (48.98)	0.800	-
Age, median (range), years	38.3 ± 14.7	36.05 ± 3.03	41.70 ± 14.7	0.128	-
Disease duration, median (range), years	38.3±14.7	30 (18.0, 51.0)	5 (18.0, 78.0)	0.108	-
Extent of colitis				0.029	-
Pancolitis (E3)	25 (34.72)	13 (56.52)	12 (24.49)		0.021 (E3 vs E2)
Left-sided colitis (E2)	28 (38.89)	6 (26.09)	22 (44.90)		1.000 (E2 vs E1)
Proctitis (E1)	19 (26.39)	4 (17.39)	15 (30.61)		0.037 (E1 vs E3)
MES				0.002	-
Mayo 0	55 (76.39)	12 (52.17)	43 (87.76)		0.048 (Mayo 0 vs Mayo 1)
Mayo 1	9 (12.50)	5 (21.74)	4 (8.16)		0.620 (Mayo 1 vs Mayo 2)
Mayo 2	8 (11.11)	6 (26.09)	2 (4.08)		0.005 (Mayo 2 vs Mayo 0)
Mayo 3	0	0	0	-	-
Use of medication for UC
Biological therapy	21 (29.17)	9 (39.13)	12 (24.49)	1.000	-
Infliximab	5 (6.94)	2 (8.70)	3 (17.39)
Vedolizumab	14 (19.44)	6 (26.09)	8 (17.39)
Ustekinumab	2 (2.78)	1 (4.35)	1 (17.39)
Non-biological therapy	49 (68.05)	23 (100)	26 (53.06)	0.703	-
Mesalazine	47 (65.28)	23 (100)	24 (48.98)
Steroids	4 (5.56)	3 (13.04)	1 (4.35)
Immunosuppressants	3 (4.17)	2 (8.70)	1 (4.35)
CRP mean (range) mg/dL	1.9 (0.9, 6.9)	5.17 (0.78, 20.27)	1.44 (0.79, 3.33)	0.042	-

ECSS: Endoscopic scoring; MES: Mayo endoscopy score; CRP: C-reactive protein; UC: Ulcerative colitis.

Table 5 Comparison of endocytoscopic findings

Parameter	ECSS-active (n = 23)	ECSS-inactive (n = 49)	P value (Mann-Whitney U)
ECSS, median (range)	18.00 (16.00, 20.00)	7.00 (4.50, 9.50)	< 0.001
Crypt orifice, median (range)	5.00 (4.50, 5.50)	0.00 (0.00, 2.00)	< 0.001
Crypt space, median (range)	9.00 (7.50, 10.50)	5.00 (3.25, 6.75)	< 0.001
Inflammatory cell infiltration, median (range)	5.00 (4.00, 6.00)	0.00 (0.00, 2.00)	< 0.001

ECSS: Endoscopic scoring.

Table 6 Comparison of endocytoscopic findings, n (%)

Characteristics	ECSS-active (n = 23)	ECSS-inactive (n = 49)	P value
Total score of ECSS	413	346	-
Crypt orifice (number of patients)
0	10 (43.48)	42 (85.71)	0.000
1	22 (95.65)	15 (30.61)	0.000
2	3 (13.04)	1 (2.04)	0.177
Crypt space (number of patients)
0	3 (13.04)	25 (51.02)	0.002
1	14 (60.87)	31 (63.27)	0.845
2	22 (95.65)	26 (53.06)	0.001
3	3 (13.04)	1 (2.04)	0.177
Ductules (number of patients)
0	7 (30.43)	42 (85.71)	0.000
1	22 (95.65)	21 (42.86)	0.000
2	10 (43.48)	1 (2.04)	0.000

ECSS: Endoscopic scoring.