Development of a new scoring system for assessment of mucosal healing in IBD by using the newly introduced BLI (Blue Light Imaging) technology

Introduction:

Increased vascular permeability and angiogenesis play a crucial role in the pathogenesis of inflammatory bowel disease (IBD). Magnifying endoscopy and chromoendoscopy have been shown to be reliable tools for predicting histological assessment of severity in patients with mild or even inactive disease. BLI was most recently introduced as a novel chromoendoscopy technique based on 4 independently acting LEDs and allows for a clear visualization of the mucosal vascular and surface pattern morphology.

Aims:

Primary objective of the study was to develop for the first time a simple classification system for in vivo assessment of mucosal healing in IBD patients by using the novel BLI technology. Second study objective was to evaluate the performance of the new classification during real time colonoscopy.

Material and methods:

In the first phase, the capacity of experienced endoscopists to predict the mucosal healing in IBD was assessed. In the second phase, a simplified classification was developed allowing for histologic prediction. At least, a pilot clinical evaluation was performed during real-time colonoscopy.

Results:

A simple classification system for assessment of mucosal healing by using the novel introduced BLI technology was developed. The classification system consists of 3 different parameters for the surface pattern morphology and 3 different parameters for the vascular pattern morphology. Sensitivity and specificity of the new classification were calculated as 91% and 95%, respectively. Accuracy was calculated as 95% with positive and negative predictive values of 95% and 91%, respectively.

Conclusion:

This is the first study evaluating the novel BLI technology for in vivo assessment of mucosal healing compared to white-light endoscopy and histology. The proposed classification allowed for adequate in vivo assessment of mucosa healing. Further prospective multicenter trials should now confirm these preliminary results.