THE PROGNOSTIC VALUE OF MICROSCOPIC FEATURES BEYOND ENDOSCOPIC MARGIN AT THE TIME OF DIAGNOSIS IN ULCERATIVE COLITIS
Catarina F. Gomes*1, Pierre Ellul2, Alexandra Almeida3, Barbara Morão1, Catarina F. Gouveia1, Catarina Callé6, Tiffany Buhagiar2, Abigail Attard2, Joana C. Branco4, Jaime Rodrigues5, Cristina Teixeira7, Francisca Dias de Castro8, Gonçalo Nunes9, Mariana Brito10, Marília Antunes3, Marília Cravo1, Paula Borralho6, Joana Torres1
1Hospital Beatriz Ângelo, Lisbon, Portugal; 2Mater Dei Hospital, Malta, Malta; 3Faculty of Sciences of University of Lisbon, Lisbon, Portugal; 4Hospital Prof. Doutor Fernando Fonseca, Amadora, Portugal; 5Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal; 6Hospital CUF Descobertas, Lisbon, Portugal; 7Centro Hospitalar de Setúbal, Setúbal, Portugal; 8Hospital da Senhora da Oliveira, Guimarães, Portugal; 9Hospital Garcia de Orta, Lisbon, Portugal; 10Hospital Garcia de Orta, Lisbon, Portugal
Background: Patients with UC are categorized in 3 major subgroups according to disease extent (E1 - proctitis, E2- left colitis, and E3- extensive colitis) based on the endoscopic extent of inflammation at the time of diagnosis. During this index colonoscopy, it is recommended that biopsies throughout the different segments of the colon (inflamed and uninflamed) are collected. However, the prevalence of microscopic inflammation beyond the endoscopically inflamed margin, as well its prognostic value in important UC-related outcomes, remains unknown. Purpose: Evaluate the presence of histologic inflammation beyond endoscopic margin and its prognostic value in UC-related outcomes. Methods: Multicenter restrospective study in E1 and E2 newly diagnosed, therapy-naïve UC patients. Biopsies from inflamed and uninflamed areas, collected during the index colonoscopy were retrieved, reviewed by 2 pathologists, and assessed for the presence of inflammatory changes using a validated score (Nancy score). The presence of inflammation above the endoscopic margin was assessed and its impact on composite outcome (need for steroids, hospitalization, surgery or therapy escalation, acute severe UC or disease proximal extension) during follow-up was evaluated using survival analysis. Results: 188 slides from 48 patients (56,3% men, median age at diagnosis 47 years [17-70], median follow-up 36,3 months [2-328]) with an inaugural diagnosis of E1 (64,6%) or E2 (35,4%) were included. Endoscopic Mayo score was mild or moderate in the majority of patients (31,3% and 52,1% respectively). Overall, 70,8% had at least some evidence of histologic inflammation above the macroscopically inflamed margin, which was more prevalent in the right colon (61,8%). The most frequent histologic feature was mild chronic inflammatory infiltrate (85,3%). During the follow-up, 27,1% had at least one adverse outcome. Inflammation beyond the endoscopic margin was present in the following outcomes: 2/2 hospitalisations, 1/1 severe episode of UC, 4/4 disease extension, 5/7 steroids course and 5/9 escalation therapy. No association was found between these outcomes and the presence or absence of histologic inflammation beyond endoscopic margin (p=0,57). In the survival analysis, the median time to an adverse outcome was lower in patients with histologic involvement beyond the endoscopic margin, albeit non-significantly (80,1 vs 108,7 months, p=ns), likely due to small sample size. Conclusions: In our cohort, 70,8% of patients with proctitis and left colitis presented histological involvement beyond the endoscopic margin at the time diagnosis. In this small cohort, the presence of inflammation beyond the endoscopic margin had no impact in UC-related outcomes.
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