CAN SIGMOIDOSCOPY REPLACE COLONOSCOPY WHEN EVALUATING PATIENTS WITH ULCERATIVE COLITIS?

Aims:

Ulcerative colitis (UC) is a chronic inflammatory bowel disease of unknown etiology and is a lifelong disease repeating clinical improvement and aggravation. Endoscopic severity assessment is very important, because the severity assessment is related to the prognosis of the UC patient. Colonoscopy is able to identify the entire field, but is accompanied by complication and the preparation process is difficult. The aim of this study is to evaluate the endoscopic tool to assessing severity of ulcerative colitis during follow up UC patients.

Methods:

The subjects were 183 UC patients who were diagnosed and followed up at Chosun University Hospital from 2013 January to 2017 December. Among them, 101 patients with follow-up colonoscopy were enrolled and retrospectively evaluated for endoscopic severity. The severity is assessed by colonoscopy alone, inspector determines endoscopic severity of follow up UC patients from rectosigmoid and proximal colon. The scale of endoscopic severity is endoscopic mayo score and ulcerative colitis endoscopic index scale (UCEIS).

Results:

Of the 101 patients, 40 has lesions limited to the rectosigmoid colon.(39%) The average of endoscopic mayo score of entire colon is 1.21 and in case of rectosigmoid colon is 1.07. The average of UCEIS of entire colon is 2.24 and in case of rectosigmoid colon is 1.94. The agreement endoscopic mayo score between the each site is observed with a kappa value of 0.83 (p = 0.00), and agreement of UCEIS between the each site is observed with a kappa value of 0.840 (p = 0.00).

Conclusions:

There is a very high level of agreement between entire colon severity and rectosigmoid colon severity in followed UC patients. Sigmoidoscopy is a good modality for evaluating the endoscopic severity of followed UC patients, considering complication and high cost.