Is Endoscopic examination alone adequate in determining the extent of disease in ulcerative colitis?

Abstract

BACKGROUND : Endoscopic and histological examination of the mucosa are the mainstay in the diagnosis of ulcerative colitis. Assessing the extent of disease is important in the management of these patients. Sometimes an endoscopic examination alone is performed without biopsy and histological examination. OBJECTIVE: To compare the extent of disease in ulcerative colitis as assessed endoscopically versus that determined histologically. METHOD: 41 patients with ulcerative colitis were identified. In each of these patients endoscopy was performed and the appearance was recorded. In each patient 1-6 mucosal biopsies (mean - 3.2) were obtained for histological evaluation. A total of 136 biopsies were examined histologically and compared with the endoscopic appearance of the corresponding area of the bowel. The sensitivity of endoscopy in detecting the presence of true inflammation was also studied for the different regions of the bowel. RESULTS: 125 biopsies showed histological involvement. The endoscopy and histology were both positive in 68. The endoscopy was negative whilst the histology was positive in 57 biopsies. Endoscopy and histology were both negative in 10 biopsies and endoscopy alone was positive in only one biopsy.The kappa value of agreement was 0.136 denoting poor agreement between endoscopy and histology.Endoscopic examination had a high sensitivity in detecting proctitis. When more proximal regions of the bowel were biopsied, the sensitivity of endoscopic examination in detecting histological inflammation gradually declined. CONCLUSION: Since endoscopy and histology show poor agreement it is recommended that both should be performed to assess the true extent of disease in ulcerative colitis.