Usefulness of texture and color enhancement imaging in assessing mucosal healing in patients with ulcerative colitis

Background and aims: Endoscopic remission is known to be defined as a Mayo endoscopic subscore (MES) of <= 1 in patients with ulcerative colitis (UC). However, some individuals experience relapse even after showing endoscopic remission under white-light imaging (WLI), and no tool exists that can detect these individuals. The aim of this study was to clarify the usefulness of texture and color enhancement imaging (TXI) in the assessment of inflammation in patients with UC. Methods: This was a prospective, single-arm, observational study conducted at a university hospital. From January 2021 to December 2021, 146 UC patients with endoscopic remission were enrolled. Images were evaluated by WLI, TXI, and pathologic evaluation, followed by prognostic studies. The primary endpoint of the study was the cumulative relapse of UC in each TXI score. The secondary endpoints were the association between TXI and pathologic scores, predictors of relapse, and interobserver agreement between the MES and TXI scores. Results: Patients with TXI score 2 had significantly lower UC relapse-free rates than did those with TXI scores 0-1 (log-rank test, P < .01). When pathologic remission was defined as Matts grade <= 2, the rate of pathologic remission decreased significantly with higher TXI scores (P = .01). In multivariate analysis, TXI score 2 was the only risk factor for UC relapse (P < .01; hazard ratio, 4.16; 95% confidence interval, 1.72-10.04). Interobserver agreement on the TXI score was good (k = 0.597-0.823). Conclusion: TXI can be used to identify populations with poor prognosis in MES 1, for whom treatment intensification has been controversial.

Automated summary

This study aimed to evaluate the usefulness of texture and color enhancement imaging (TXI) in assessing the degree of inflammation in patients with ulcerative colitis (UC). The results showed that patients with a TXI score of 2 had significantly lower UC relapse rates compared to those with TXI scores of 0-1. TXI score was significantly associated with pathologic scores, and a TXI score of 2 was identified as the only risk factor for UC relapse. Therefore, TXI can be used to identify patients with poor prognosis in MES 1 and provide evidence for controversial treatment intensification.