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Comparative Study
. 2021 Apr;160(5):1558-1569.e8.
doi: 10.1053/j.gastro.2020.12.024. Epub 2021 Feb 6.

An International Multicenter Real-Life Prospective Study of Electronic Chromoendoscopy Score PICaSSO in Ulcerative Colitis

Marietta Iacucci  1 , Samuel C L Smith  2 , Alina Bazarova  3 , Uday N Shivaji  4 , Pradeep Bhandari  5 , Rosanna Cannatelli  6 , Marco Daperno  7 , Jose Ferraz  8 , Martin Goetz  9 , Xianyong Gui  10 , Bu Hayee  11 , Gert De Hertogh  12 , Mark Lazarev  13 , Jim Li  14 , Olga M Nardone  2 , Adolfo Parra-Blanco  15 , Luca Pastorelli  16 , Remo Panaccione  8 , Vincenzo Occhipinti  16 , Timo Rath  17 , Gian Eugenio Tontini  18 , Michael Vieth  19 , Vincenzo Villanacci  20 , Davide Zardo  21 , Raf Bisschops  12 , Ralf Kiesslich  22 , Subrata Ghosh  23
Affiliations
Comparative Study

An International Multicenter Real-Life Prospective Study of Electronic Chromoendoscopy Score PICaSSO in Ulcerative Colitis

Marietta Iacucci et al. Gastroenterology. 2021 Apr.

Abstract

Background & aims: Endoscopic and histologic remission are important goals in the treatment of ulcerative colitis (UC). We investigated the correlation of the recently developed Paddington International Virtual ChromoendoScopy ScOre (PICaSSO) and other established endoscopic scores against multiple histological indices and prospectively assessed outcomes.

Methods: In this prospective multicenter international study, inflammatory activity was assessed with high-definition and virtual chromoendoscopy in the rectum and sigmoid using the Mayo Endoscopic Score (MES), UC Endoscopic Index of Severity (UCEIS), and PICaSSO. Targeted biopsies were taken for assessment using Robarts Histological Index (RHI), Nancy Histological index (NHI), ECAP (Extent, Chronicity, Activity, Plus score), Geboes, and Villanacci. Follow-up data were obtained at 6 and 12 months after colonoscopy.

Results: A total of 307 patients were recruited. There was strong correlation between PICaSSO and histology scores, significantly superior to correlation coefficients of MES and UCEIS with histology scores. A PICaSSO score of ≤3 detected histologic remission by RHI (≤3 + absence of neutrophils) with area under the receiver operating characteristic curve (AUROC) 0.90 (95% confidence interval [CI] 0.86-0.94) and NHI (≤1) AUROC 0.82 (95% CI 0.77-0.87). The interobserver agreement for PICaSSO was 0.88 (95% CI 0.83-0.92). At 6- and 12-months follow-up, PICaSSO score ≤3 predicted better outcomes than PICaSSO >3 (hazard ratio [HR] 0.19 [0.11-0.33] and 0.22 [0.13-0.34], respectively),} as well as PICaSSO 4-8 (HR 0.25 [0.12-0.53] and 0.22 (0.12-0.39), respectively) and similar to histologic remission.

Conclusion: In this first real-life multicenter study, the PICaSSO score correlated strongly with multiple histological indices. Furthermore, PICaSSO score predicted specified clinical outcomes at 6 and 12 months, similar to histology. Thus, PICaSSO can be a useful endoscopic tool in the therapeutic management of UC.

Keywords: Endoscopic Remission; Histological Remission; Mucosal Healing; Ulcerative Colitis; Virtual Electronic Chromoendoscopy.

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