Gian Eugenio Tontini1, Jonas Mudter2, Michael Vieth3, Claudia Günther2, Valentina Milani4, Raja Atreya2, Timo Rath2, Andreas Nägel2, Giorgia Hatem5, Giacomo Carlo Sturniolo5, Maurizio Vecchi6, Markus F Neurath2, Peter R Galle7, Andrea Buda8, Helmut Neumann9. 1. Department of Medicine I, University of Erlangen-Nürnberg, Erlangen, Germany; Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 2. Department of Medicine I, University of Erlangen-Nürnberg, Erlangen, Germany. 3. Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany. 4. IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy. 5. Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy. 6. Gastroenterology and Digestive Endoscopy Unit, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy; Department of Biomedical Sciences for Health, University of Milan, Milan, Italy. 7. First Medical Department, University Medical Center Mainz, Mainz, Germany. 8. Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padua, Padua, Italy; Gastroenterology and Digestive Endoscopy Unit, Ospedale di Feltre, Feltre, Italy. 9. Department of Medicine I, University of Erlangen-Nürnberg, Erlangen, Germany; First Medical Department, University Medical Center Mainz, Mainz, Germany.
Abstract
BACKGROUND AND AIMS: Assessment of prognostic factors in patients with Crohn's disease (CD) is of pivotal importance for early intervention and "treat-to-target" strategies. Confocal laser endomicroscopy (CLE) enables on-demand in vivo characterization of mucosal inflammatory and architectural changes during endoscopy. We prospectively assessed the value of CLE for prediction of clinical outcome parameters in CD. METHODS: Consecutive patients with CD undergoing colonoscopy were included in a multicenter study. Confocal imaging focused on 2 highly reproducible histologic hallmarks of active colonic inflammation: focal cryptitis and crypt architectural abnormality. We evaluated whether CLE, CD endoscopic index of severity (CDEIS), serum C-reactive protein (CRP), and CD activity index (CDAI) were associated with the risk of medical treatment escalation, transmural adverse events, and CD-related hospitalization or surgery during a 4-year follow-up. RESULTS: Among 49 patients (53% men, median age, 39 years), baseline CRP was ≥5 mg/L in 47%, CDEIS ≥3 in 75%, and CDAI >150 in 51%. Focal cryptitis and crypt architectural abnormality were observed in 63% (CLE+ group). CLE+ patients showed an increased incidence of medical treatment escalation (P < .001; relative risk [RR] = 3.27) and transmural lesions (P = .025; RR = 1.70), whereas patients with CRP ≥5 mg/L had increased CD-related hospitalization and surgery (P = .020, RR = 2.71) at 1-year follow-up. No further association with prognostic clinical outcomes was found over the 1-year follow-up as well as for CDEIS and CDAI at any time. CONCLUSIONS: CLE reveals CD-related features of mucosal inflammation and allows for early prediction of relevant clinical outcomes. Further studies should now address whether this promising prognostic tool could refine the timing of treatment strategies in patients with CD.
BACKGROUND AND AIMS: Assessment of prognostic factors in patients with Crohn's disease (CD) is of pivotal importance for early intervention and "treat-to-target" strategies. Confocal laser endomicroscopy (CLE) enables on-demand in vivo characterization of mucosal inflammatory and architectural changes during endoscopy. We prospectively assessed the value of CLE for prediction of clinical outcome parameters in CD. METHODS: Consecutive patients with CD undergoing colonoscopy were included in a multicenter study. Confocal imaging focused on 2 highly reproducible histologic hallmarks of active colonic inflammation: focal cryptitis and crypt architectural abnormality. We evaluated whether CLE, CD endoscopic index of severity (CDEIS), serum C-reactive protein (CRP), and CD activity index (CDAI) were associated with the risk of medical treatment escalation, transmural adverse events, and CD-related hospitalization or surgery during a 4-year follow-up. RESULTS: Among 49 patients (53% men, median age, 39 years), baseline CRP was ≥5 mg/L in 47%, CDEIS ≥3 in 75%, and CDAI >150 in 51%. Focal cryptitis and crypt architectural abnormality were observed in 63% (CLE+ group). CLE+ patients showed an increased incidence of medical treatment escalation (P < .001; relative risk [RR] = 3.27) and transmural lesions (P = .025; RR = 1.70), whereas patients with CRP ≥5 mg/L had increased CD-related hospitalization and surgery (P = .020, RR = 2.71) at 1-year follow-up. No further association with prognostic clinical outcomes was found over the 1-year follow-up as well as for CDEIS and CDAI at any time. CONCLUSIONS: CLE reveals CD-related features of mucosal inflammation and allows for early prediction of relevant clinical outcomes. Further studies should now address whether this promising prognostic tool could refine the timing of treatment strategies in patients with CD.
Authors: Mazen R Al-Mansour; Antonio Caycedo-Marulanda; Brian R Davis; Abdulrahim Alawashez; Salvatore Docimo; Alia Qureshi; Shawn Tsuda Journal: Surg Endosc Date: 2020-05-13 Impact factor: 4.584
Authors: Abel Swaan; Christophe K Mannaerts; Matthijs Jv Scheltema; Jakko A Nieuwenhuijzen; C Dilara Savci-Heijink; Jean Jmch de la Rosette; R Jeroen A van Moorselaar; Ton G van Leeuwen; Theo M de Reijke; Daniel Martijn de Bruin Journal: JMIR Res Protoc Date: 2018-05-21
Authors: Matti Sievert; Marc Aubreville; Antoniu-Oreste Gostian; Konstantinos Mantsopoulos; Michael Koch; Sarina Katrin Mueller; Markus Eckstein; Robin Rupp; Florian Stelzle; Nicolai Oetter; Andreas Maier; Heinrich Iro; Miguel Goncalves Journal: Eur Arch Otorhinolaryngol Date: 2022-02-28 Impact factor: 3.236