Prospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. Jul 16, 2025; 17(7): 108082
Published online Jul 16, 2025. doi: 10.4253/wjge.v17.i7.108082
Endocytoscopy in real-time assessment of histological and endoscopic activity in ulcerative colitis
Thanaboon Chaemsupaphan, Mohammad Shir Ali, Caroline Fung, Sudarshan Paramsothy, Rupert W Leong
Thanaboon Chaemsupaphan, Mohammad Shir Ali, Sudarshan Paramsothy, Rupert W Leong, Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Sydney 2139, New South Wales, Australia
Thanaboon Chaemsupaphan, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Krung Thep Maha Nakhon, Thailand
Caroline Fung, Department of Anatomical Pathology, Concord Repatriation General Hospital, Sydney 2139, New South Wales, Australia
Sudarshan Paramsothy, Rupert W Leong, Department of Medicine, Faculty of Medicine and Health, The University of Sydney, Sydney 2139, New South Wales, Australia
Rupert W Leong, Department of Medicine, Faculty of Medicine and Health Sciences, Macquarie University, Sydney 2139, New South Wales, Australia
Author contributions: Chaemsupaphan T, Shir Ali M, Paramsothy S, and Leong RW were involved in methodology and conducted the investigation; Chaemsupaphan T and Fung C performed data analysis; Chaemsupaphan T and Leong RW wrote the original draft; Leong RW designed and supervised the study. All authors have edited and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Sydney Local Health District Human Research Ethics Committee, No. 2023/ETH01690.
Clinical trial registration statement: The procedure under investigation, endocytoscopy, is becoming a standard diagnostic tool and is already approved by the Therapeutic Goods Administration for clinical use in Australia. There is not required a clinical trial registration.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: Paramsothy S has received speaking and consulting fees from AbbVie, Janssen, and Takeda. Leong RW declares advisory board membership: AbbVie, Aspen, BMS, Celgene, Celltrion, Chiesi, Ferring, Glutagen, Hospira, Janssen, Lilly, MSD, Novartis, Pfizer, Prometheus Biosciences, and Takeda; research grant recipient from Joanna Tiddy University of Sydney, McKusker Charitable Foundation, Celltrion, Shire, Janssen, Takeda, Gastroenterological Society of Australia, National Health and Medical Research Council, Gutsy Group, Pfizer, and Medical Research Future Fund Australia. The others have no conflict of interest to disclose.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: Data, analytic methods, and study materials are available to other researchers upon request to the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rupert W Leong, MD, Consultant, FRACP, Full Professor, Department of Gastroenterology and Liver Services, Concord Repatriation General Hospital, Hospital Road, Sydney 2139, New South Wales, Australia. rupertleong@hotmail.com
Received: April 7, 2025
Revised: April 23, 2025
Accepted: May 26, 2025
Published online: July 16, 2025
Processing time: 95 Days and 4.6 Hours
Abstract
BACKGROUND

Endocytoscopy is an advanced imaging modality that provides real-time, ultra-high magnification views of the intestinal mucosa. In ulcerative colitis (UC), the combined assessment of endoscopic and histological remission is now becoming a standard practice. However, histological evaluation typically falls outside the scope of the endoscopist. By offering in vivo microscopic imaging, endocytoscopy has the potential to streamline workflow and enhance efficiency in assessing UC activity.

AIM

To evaluate the utility of real-time endocytoscopy in assessing endoscopic and histological disease activity in UC, and to validate endocytoscopic scoring systems.

METHODS

This study was conducted at Concord Hospital. Patients with UC who consented to undergo colonoscopy with endocytoscopy were enrolled. Data collected included patient demographics, clinical disease activity, Mayo endoscopic score (MES), and endocytoscopic features such as crypt architecture, intercrypt distance and cellular infiltration. Correlation between endocytoscopic findings were evaluated against MES and the Nancy histological index. Agreement and validation were assessed using the ErLangen Endocytoscopy in ColiTis (ELECT) score and the endocytoscopy score (ECSS), applying Kappa (κ) statistics and Spearman’s correlation coefficient (r).

RESULTS

A total of 61 colonic segments from 15 patients were assessed, with 187 analyzable endocytoscopic images. Endocytoscopy showed significant correlation with the MES using both the ECSS (κ = 0.60, P < 0.001; r = 0.78, P < 0.001) and ELECT (κ = 0.88, P < 0.001; r = 0.81, P < 0.001) scoring systems. Similarly, correlations with the Nancy histological index were significant for both ECSS (κ = 0.47, P < 0.001; r = 0.69, P < 0.001) and ELECT (κ = 0.88, P < 0.001; r = 0.74, P < 0.001). The ELECT score demonstrated superior diagnostic accuracy in identifying histological remission, with a sensitivity of 100%, specificity of 85%, and an area under the receiver operating characteristic curve of 0.90 (95% confidence interval: 0.78-1.00), compared to 68.3%, 85%, and an area under the receiver operating characteristic curve of 0.88 (95% confidence interval: 0.75-1.00) for the ECSS. No serious adverse events occurred, except for transient urinary discoloration due to methylene blue excretion.

CONCLUSION

Endocytoscopy allows for real-time, simultaneous assessment of endoscopic and histological activity in UC and has been proven to be accurate, safe, and well-tolerated. Compared with the ECSS, the ELECT score showed superior concordance with histological findings.

Keywords: Ulcerative colitis; Endocytoscopy; Histology; Endocytoscopy score; Histological activity; Endoscopic activity

Core Tip: Endocytoscopy is an advanced imaging technique providing ultra-high magnification for real-time mucosal assessment. This prospective study evaluated its role in simultaneously assessing endoscopic and histological activity in ulcerative colitis. Endocytoscopy score, particularly the ErLangen Endocytoscopy in ColiTis score, correlated strongly with standard indices including the Mayo endoscopic score and the Nancy histological index. ErLangen Endocytoscopy in ColiTis outperformed the endocytoscopy score in identifying histological remission. These findings support endocytoscopy as a safe, accurate, and efficient tool that may streamline ulcerative colitis disease assessment in daily practice.