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18 - World Journal of Gastroenterology

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2524 ISSN 1007-9327 CN 14-1219/R <strong>World</strong> J Gastroenterol May 14, 2007 Volume 13 Number <strong>18</strong><br />

i�� �on��idered the ��tandard for e�al�ation <strong>of</strong> di��ea��e<br />

a�ti�ity [��� ��� .� Ob��er�ation Ob��er�ation b��er�ation �nder �nder �nder �on�entional �on�entional �on�entional �olono���opy<br />

�olono���opy<br />

�olono���opy<br />

i�� regarded a�� a�� ���ef�l ���ef�l for the e�al�ation e�al�ation <strong>of</strong> di��ea��e di��ea��e a�ti�ity�� a�ti�ity��<br />

��in�e it <strong>of</strong>fer�� dire�t ob��er�ation <strong>of</strong> m��o��al �hange����<br />

b�t it remain�� �ontro�er��ial �hether �olono���opi�<br />

grade �orrelate�� �ith hi��topathlogi� finding��.� .� �otably�� �otably��<br />

the degree <strong>of</strong> hi��tologi� inflammation �ithin biop��y<br />

��pe�imen�� doe�� oe�� not ne�e����arily ne�e����arily ne�e����arily �orrelate �orrelate �orrelate �ith �ith �ith endo���opi� endo���opi� endo���opi�<br />

abnormalitie�� [����������������� ����������������� ���������� ��������� ������ ����� ��� .�<br />

Are magnifying chromoscopic findings useful for the<br />

evaluation <strong>of</strong> UC ?<br />

Mat���moto et al reported the ���ef�lne���� ���ef�lne���� ���ef�lne���� <strong>of</strong> <strong>of</strong> magnifying<br />

magnifying<br />

�hromo���opy in the a����e����ment a����e����ment a����e����ment <strong>of</strong> ��e�erity ��e�erity ��e�erity [��� ��� .� Magnifying<br />

agnifying<br />

�olono���opy �a�� performed in �� patient�� �ith �l�erati�e �l�erati�e<br />

�oliti���� �ith �ith finding�� finding�� finding�� in in the the re�t�m re�t�m re�t�m graded graded a��ording a��ording a��ording to<br />

to<br />

net�ork pattern ���P�� ���P�� ���P�� and �ryptal �ryptal �ryptal opening ��O��.� ��O��.� ��O��.� ��O��.� ��O��.� The<br />

The<br />

The<br />

�lini�al�� endo���opi� and hi��tologi� grade�� <strong>of</strong> a�ti�ity did<br />

not differ bet�een gro�p�� �ategori�ed �ategori�ed by the pre��en�e pre��en�e pre��en�e or<br />

�������� �f ���� ��������.� ������r�� ������r�� ������r�� ���� ���� ���� ��� ��� ��� ��� ��� ��� f���ur��� f���ur��� f���ur���<br />

�ere �o�pled�� patient�� �ith both �i��ible �i��ible �i��ible ��P ��P ��P and and �O �O �O had<br />

had<br />

a lo�er �lini�al a�ti�ity inde� and lo�er grade <strong>of</strong> hi��tologi�<br />

������������ ���� ������ �� ���� ������r ������r �������� �������� �������� ���� ���� �a�� ���� ��een.� �����.� �����.� ��een.�.� ��een.� �����.�<br />

F�rther���� the the pre��en�e pre��en�e pre��en�e <strong>of</strong> brea�he�� brea�he�� brea�he�� ea�he�� �he�� in in ���rfa�e ���rfa�e ���rfa�e ���rfa�e ���rfa�e epitheli�m epitheli�m epitheli�m epitheli�m epitheli�m<br />

may be an additional fa�tor fa�tor in f�t�re f�t�re f�t�re relap��e relap��e relap��e [�� ����� and an<br />

�l��r�� p����r� ��� ������� �y� ���������� ��l�������p�� ������<br />

may be predi�ti�e <strong>of</strong> �o�r��e [��� ��� .�<br />

F�jiya et al propo��ed a �la����ifi�ation �la����ifi�ation �la����ifi�ation ��y��tem ��y��tem ��y��tem ��y��tem for<br />

for<br />

magnifying �olono���opi� finding�� in patient�� �ith �� ��<br />

�hi�h ha�� ha�� pro�ed pro�ed ���ef�l ���ef�l ���ef�l for the e�al�ation e�al�ation e�al�ation <strong>of</strong> di��ea��e di��ea��e di��ea��e<br />

a�ti�ity and predi�tion <strong>of</strong> period�� <strong>of</strong> remi����ion [��� .� Thi�� Thi��<br />

�l�������������� r�f�r������ referen�e�� r���ul�rly� reg�larly reg�larly �rr������ arranged �ry�p� �rypt �rypt �p���������� opening���� opening���� ������<br />

a �illo����like �illo����like appearan�e�� appearan�e�� min�te min�te defe�t�� defe�t�� <strong>of</strong> epitheli�m epitheli�m<br />

�MD������� ��mall ��mall yello�i��h yello�i��h yello�i��h ��pot�� ��pot�� ��pot�� ��pot�� �S�S���� �S�S���� �S�S���� �S�S���� �S�S���� �� and and a a �oral �oral �oral �oral �oral �oral �oral �oral reef� reef� reef� reef� reef� reef� reef� reef�<br />

like appearan�e.� �olono���opi� �olono���opi� olono���opi� finding�� finding�� finding�� �nder �nder �nder �nder thi�� thi�� thi�� thi��<br />

�l�������������� ��r� ���p�r�� ���� ������p����l����� ����������<br />

�� 61 p�������� ��� ��� u���ful������ �f ��� �l�������������� f�r<br />

predi�ting relap��e �a�� pro��pe�ti�ely analy�ed in ��.� �nder �nder �nder<br />

�on�entional �olono���opi� e�amination�� all area�� e�al�ated<br />

a�� Matt������ grade grade �� � had a �orre��ponding �orre��ponding �orre��ponding hi��topathologi�<br />

hi��topathologi�<br />

hi��topathologi�<br />

grade <strong>of</strong> �.� �n �n �n �ontra��t�� �ontra��t�� �ontra��t�� mo��t mo��t mo��t area�� area�� area�� a����e����ed a����e����ed a����e����ed a�� a�� a�� Matt���� Matt���� Matt���� �� grade<br />

grade<br />

� or � �ere diagno��ed a�� hi��topathologi� grade � or higher.�<br />

�n �ontra��t���� Matt���� Matt���� �� grade grade � �� � m��o��a m��o��a m��o��a m��o��a had had hi��topathologi�<br />

hi��topathologi�<br />

hi��topathologi�<br />

hi��topathologi�<br />

���������� ���� ��r��� fr�� qu�������� �� ������ ���������.� ������ The��e The��e<br />

re���lt�� ���gge��t ���gge��t that �hile �hile �hile normal and di��ea��ed di��ea��ed di��ea��ed di��ea��ed m��o��a m��o��a m��o��a m��o��a are<br />

ea��ily re�ogni�ed by �on�entional �olono���opy�� a����e����ment ment<br />

<strong>of</strong> the min�te min�te m��o��al m��o��al �hange�� �hange�� that refle�t refle�t ��moldering ��moldering<br />

������p����l����� ������������ ��� i�� �u�� m��h l����� le���� ��u�������ful �����e����f�l [��������� ��������� �� .�<br />

�nder nder magnifying �olono���opi� �olono���opi� e�amination�� e�amination�� in in �ontra��t�� �ontra��t�� �ontra��t��<br />

�� ���.������ ���.������ ���.������ <strong>of</strong> <strong>of</strong> the the �� �� �� area�� area�� area�� in in �hi�h �hi�h �hi�h reg�larly reg�larly reg�larly arranged<br />

arranged<br />

�rypt opening�� or a �illo����like appearan�e appearan�e �a�� �a�� �a�� dete�ted dete�ted dete�ted<br />

had a �orre��ponding hi��topathologi� grade <strong>of</strong> ��� �hile �hile all<br />

area�� �ith �ith MD��� MD��� MD��� S�S�� S�S�� S�S�� or the �oral �oral �oral reef�like reef�like reef�like appearan�e appearan�e appearan�e<br />

had a �orre��ponding hi��topathologi� grade <strong>of</strong> �� � or higher.� higher.� higher.�<br />

�n parti��lar�� �� the �orrelation �orrelation bet�een bet�een hi��topathologi�<br />

hi��topathologi�<br />

grade and magnifying �olono���opi� finding�� ���r<br />

� = �.������<br />

�a�� better than that for hi��topathologi� grade �er�����<br />

�on�entional �olono���opy ��r � � = �.������.� Thi�� Thi�� Thi�� ��t�dy ��t�dy ��t�dy fo�nd fo�nd fo�nd<br />

that patient�� in �hom MD� �a�� ob��er�ed d�ring �lini�al<br />

remi����ion fre��ently e�perien�ed e�perien�ed relap��e relap��e relap��e �ithin �ithin �ithin ��hort ��hort ��hort<br />

p�r����� �6 �6 �6 ���� ���� ���� ���p�r�� ���p�r�� ���p�r�� ���� ���� ���� ������ ������ ������ ������ �����u� �����u� �����u� �����u� �����u� ����� ����� ����� ����� ����� ���������� ���������� ���������� ���������� ����������<br />

www.wjgnet.com<br />

A B<br />

C D<br />

Figure 1 Grading <strong>of</strong> pit structures in the colorectal mucosa <strong>of</strong> patients with<br />

inactive UC.MCS grade 1: Pits are small, round, and regularly arranged (A). MCS<br />

grade 2: Pits are rather large, oval, and somewhat irregular in arrangement (B).<br />

MCS grade 3: Pits are <strong>of</strong> various shapes and sizes, and irregularly arranged (C).<br />

MCS grade 4: Dispersed pits vary in morphology and are associated with the<br />

presence <strong>of</strong> small erosions (D).<br />

and that ���� ���� ���� <strong>of</strong> patient�� patient�� patient�� �ho �ho �ho �nder�ent �nder�ent �nder�ent �lini�al �lini�al �lini�al remi����ion remi����ion remi����ion<br />

����ll ��� ������ �������� �u����� ���� MDE [��� .� Thi�� latter<br />

finding �orrelate�� �orrelate�� �ith �ith a pre�io��� pre�io��� pre�io��� pre�io��� finding finding finding that that that ���� ���� ���� ���� ���� ���� ���� ���� to<br />

to<br />

to<br />

to<br />

���� <strong>of</strong> patient�� in remi����ion a�� determined by �lini�al<br />

��ymptom�� �ere ��till in the a�ti�e a�ti�e ��tage ��tage ��tage <strong>of</strong> �l�erati�e �l�erati�e �l�erati�e �l�erati�e �oliti�� �oliti�� �oliti�� �oliti�� �oliti��<br />

������ �� ������p����l����� ���������� [������� ������� ������ ����� ��� .�<br />

Magnifying chromoscopic findings and prediction <strong>of</strong><br />

relapse<br />

�i��hio et al [��� ��� reported that magnifying��olono���opy<br />

magnifying��olono���opy<br />

magnifying��olono���opy<br />

�olono���opy<br />

�M�S�� grade �a�� a����o�iated �ith the degree <strong>of</strong> hi��tologi�al<br />

inflammation and m��o��al �L�� a�ti�ity in ��ie���ent<br />

patient�� �ith �l�erati�e �l�erati�e �oliti���� �oliti���� �oliti���� and and might might predi�t predi�t predi�t the<br />

the<br />

probability <strong>of</strong> ���b��e��ent di��ea��e relap��e in patient�� �ith<br />

�l�erati�e �oliti�� �oliti�� in remi����ion.� remi����ion.� Magnifying �olono���opy<br />

�olono���opy<br />

�olono���opy<br />

�olono���opy<br />

�a�� performed in ��� patient�� in remi����ion�� �� and the he<br />

relation��hip bet�een pit pattern���� �L�� a�ti�ity�� and<br />

hi��tologi�al di��ea��e a�ti�ity �a�� e�al�ated.� Pit pattern�� pattern�� pattern�� in<br />

��� r����l �u����� ��r� �l���������� ���� f�ur MCS ��r����� ��<br />

the ba��i�� <strong>of</strong> ��i�e�� ��hape�� and arrangement �Fig�re �Fig�re Fig�re ���.� ���.� ���.� ��.� .� The<br />

The<br />

The<br />

patient�� �ere then follo�ed follo�ed follo�ed �ntil �ntil �ntil relap��e relap��e relap��e or for a ma�im�m ma�im�m ma�im�m ma�im�m ma�im�m<br />

<strong>of</strong> �� mo.� �e���lt�� �e���lt�� ��ho�ed ��ho�ed a po��iti�e po��iti�e po��iti�e �orrelation �orrelation �orrelation bet�een bet�een bet�een<br />

M�S grade�� hi��tologi�al grade�� and m��o��al �L�� a�ti�ity.�<br />

M�lti�ariate proportional ha�ard model analy��i�� ��ho�ed<br />

that M�S grade �a�� a ��ignifi�ant predi�tor <strong>of</strong> relap��e.�<br />

Moreo�er�� the �aplan�Meier �aplan�Meier e��timate e��timate e��timate <strong>of</strong> <strong>of</strong> relap��e relap��e relap��e relap��e d�ring d�ring d�ring d�ring<br />

�� mo follo���p �a�� fo�nd to in�rea��e �ith in�rea��ing<br />

M�S grade�� �ith per�entage�� �� <strong>of</strong> ��� ��� ��� for grade ��� ��� ��� ���� ���� ���� for<br />

grade ��� ���� for grade ��� and ���� for grade �.� �ltho�gh �ltho�gh �ltho�gh<br />

M�S grade po��iti�ely �orrelated �ith hi��tologi�al grade<br />

and m��o��al �L�� a�ti�ity�� the��e latter parameter�� �ere<br />

le���� a���rate predi�tor�� <strong>of</strong> relap��e.� One rea��on rea��on rea��on may be<br />

that they are a����e����ed in biop��y ��pe�imen�� deri�ed from<br />

� ��p������ ��� l������ �r�� �f <strong>of</strong> ��l�r����l �olore�tal �olore�tal �u������� m��o��a�� m��o��a�� ���r���� �herea�� �herea��<br />

magnifying �olono���opy allo��� the ob��er�ation <strong>of</strong> a more<br />

e�tended ed and repre��entati�e repre��entati�e repre��entati�e area�� area�� area�� and and a��ordingly a��ordingly a��ordingly a��ordingly greater<br />

greater<br />

a���ra�y by M�S grading [��� .� The��e The��e finding�� finding�� demon��trate demon��trate<br />

the ���ef�lne���� <strong>of</strong> M�S M�S in the e�al�ation e�al�ation e�al�ation e�al�ation <strong>of</strong> di��ea��e di��ea��e di��ea��e di��ea��e a�ti�ity a�ti�ity a�ti�ity a�ti�ity<br />

and in predi�ting predi�ting predi�ting relap��e relap��e relap��e in in patient�� patient�� patient�� �ith �ith �ith �l�erati�e �l�erati�e �l�erati�e �l�erati�e �oliti��.� �oliti��.� �oliti��.� �oliti��.� �oliti��.�

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