| Objective: The International Organization for Inflammatory Bowel Disease Research proposes that,in addition to taking clinical healing and mucosal healing as the main thera peutic goals of Crohn’s disease,histological healing should be considered as another thera peutic goal.Our goal is to evaluate whether blue laser imaging as a novel endoscopic imaging technique can accurately assess histological inflammation in Crohn’s disease and promises to reduce tissue biopsies performed during colonoscopy to monitor the activity of inflammation in Crohn’s disease.Methods: As a cross-sectional study,A total of 52 patients who had been clearly diagnosed with Crohn’s disease and underwent colonoscopy at the endoscopy diagnosis and treatment center of our hospital were included.Colonic examinations in all patients were performed by two experienced endoscopists using Fuji blue laser imaging,and activity assessment was based on the magnified endoscopy score.Biopsy specimens of the most severely diseased area were obtained,and histological activity was assessed by the pathology physician based on the modified Riley index.Comparing endoscopic results with histological findings,Spearman correlation coefficient was applied to test the correlation between blue laser imaging and histological activity,the accuracy,sensitivity and specificity in the assessment of histological inflammation were calculated.A regression model was developed to evaluate the interpretation power of histological activity by blue laser imaging.Furthermore,the Kappa concordance test was applied to assess the agreement between the two endoscopists.Results:The SESCD score observed by white light was 16 case(30.77%)out of 0-2 points,14(26.92%)out of 3-6 points,18 cases(34.62%)out of 7-15 points,and 4 cases(7.69%)out of over 16 points.According to statistics,there were 16 cases(30.77%)of mucosal healing under white light,including 5 histologically healing,4 mild,7 moderate;14 cases(26.92%)of mild activity under white light,2 histologically healing,1 mild,11 moderate;18 cases(34.62%)of moderate activity under white light,including 2 histologically mild,13 moderate,3 severe;4 cases(7.69%)of severe activity under white light,3 moderate and1 histologically severe.The magnifying endoscopy score performed in blue laser imaging showed 7 cases(13.46%)out of 2 points and 4 cases(7.69%)out of 3 points,2 cases(3.85%)out of 4 points,12(23.08%)out of 5 points,21 cases(40.38%)out of 6 points,2 cases(3.85%)out of 7 poin ts,and 4 cases(7.69%)out of 8 points.According to statistics,there were 7 cases(13.46%)mucosal and vascular healing of blue laser,with 6 cases of histological healing and 1 cas e of mild activity;6 cases(11.54%)of mild activity under blue laser,including 1 case of histological healing,4 cases of mild activity and 1 case of moderate activity;33 cases(63.46%)of moderate activity,including 2 cases of histological mild activity and 31 cases of histological moderate activity;6 cases(11.54%)severe activity,including 2 cases of mode rate histological activity and 4 cases of severe histological activity.The total accuracy of blue laser was higher than white laser(blue: 96.15%,white: 75.00%,P<0.01).Blue laser was more accurate in assessing inflammatory healing(blue: 85.71%,white:31.25%),mild activity(blue:66.67%,white:7.14%),and moderate activity(blue:93.94%,white:68.75%),the difference was statistically significant(P<0.05).There was no significant difference in the accuracy of severe activity(blue: 66.67%,white: 25.00%)(P> 0.05),although the blue laser was more accurate than white laser.Blue laser also assessed histological activity with high sensitivity(97.78%)and specificity(85.71%).The correlation of inflammation activity and histological activity was verified by Spearman,and the correlation between white laser and histological activity was moderate(rs=0.512,95%CI:0.298-0.686,P <0.01).However the correlation between blue laser and histological activity was very strong(r s=0.884,95%CI:0.763-0.970,P <0.01).Blue laser activity and white laser activity were selected as independent variables,and histological activity as dependent variables for regression analysis.The R square values of the two regression models were 0.819 and 0.239,the F values were 226.172 and 15.682,and the regression coefficient was 0.887,0.396(P <0.05),that is,the explanatory strength of histological activity under blue laser and white laser was 0.819 and 0.239,Moreover,without changing other conditions,every 1 unit increase in activity under blue laser increased 0.887 unit,and every 1 unit increase in variable histological activity increased0.396 unit in activity under white light.Kappa consistency test was used to assessconsistency between the two endoscopists,and the Kappa values of two endoscopists under blue laser and white laser examinations were k=0.788(P<0.05)and k=0.619(P<0.05).Conclusion: Compaerd with white laser,blue laser has higher accuracy in assessing the inflammatory activity of Crohn’s disease,and has higher sensitivity and specificity,which has a very strong correlation between it and histological activity.The evaluation of histological activity of Crohn’s disease keeps the microscopic assessment of inflammatory activity consistent with that of histological activity,and is expected to reduce the tissue biopsies performed to monitor inflammatory activity during colonoscopy. |
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