In vivo colonoscopic optical coherence tomography for transmural inflammation in inflammatory bowel disease.

BACKGROUND & AIMS Transmural inflammation, a distinguishing feature of Crohn's disease (CD), cannot be assessed by conventional colonoscopy with mucosal biopsy. Our previous ex vivo study of histology-correlated optical coherence tomography (OCT) imaging on colectomy specimens of CD and ulcerative colitis (UC) showed that disruption of the layered structure of colon wall on OCT is an accurate marker for transmural inflammation of CD. We performed an in vivo colonoscopic OCT in patients with a clinical diagnosis of CD or UC using the previously established, histology-correlated OCT imaging criterion. METHODS OCT was performed in 40 patients with CD (309 images) and 30 patients with UC (292 images). Corresponding endoscopic features of mucosal inflammation were documented. Two gastroenterologists blinded to endoscopic and clinical data scored the OCT images independently to assess the feature of disrupted layered structure. RESULTS Thirty-six CD patients (90.0%) had disrupted layered structure, whereas 5 UC patients (16.7%) had disrupted layered structure (P < .001). Using the clinical diagnosis of CD or UC as the gold standard, the disrupted layered structure on OCT indicative of transmural inflammation had a diagnostic sensitivity and specificity of 90.0% (95% CI: 78.0%, 96.5%) and 83.3% (95% CI: 67.3%, 93.3%) for CD, respectively. The kappa coefficient in the interpretation of OCT images was 0.80 (95% CI: 0.75, 0.86, P < .001). CONCLUSIONS In vivo colonoscopic OCT is feasible and accurate to detect disrupted layered structure of the colon wall indicative of transmural inflammation, providing a valuable tool to distinguish CD from UC.

[1]  N. Hyman,et al.  Consequences of ileal pouch-anal anastomosis for Crohn's colitis , 1991, Diseases of the Colon & Rectum.

[2]  Elena A. Manilich,et al.  Quantification of Risk for Pouch Failure After Ileal Pouch Anal Anastomosis Surgery , 2003, Annals of surgery.

[3]  R. Whitehead.  Mucosal biopsy of the gastrointestinal tract. , 1973, Major problems in pathology.

[4]  K. Haruma,et al.  Evaluation of the colorectal wall in normal subjects and patients with ulcerative colitis using an ultrasonic catheter probe. , 1998, Gastrointestinal endoscopy.

[5]  G J Tearney,et al.  Optical Biopsy with Optical Coherence Tomography a , 1998, Annals of the New York Academy of Sciences.

[6]  F. T. de Dombal,et al.  Diagnosis of inflammatory bowel disease: an international multicentre scoring system. , 1982, British medical journal.

[7]  B E Bouma,et al.  Optical biopsy in human gastrointestinal tissue using optical coherence tomography. , 1997, The American journal of gastroenterology.

[8]  B. Bouma,et al.  Power-efficient nonreciprocal interferometer and linear-scanning fiber-optic catheter for optical coherence tomography. , 1999, Optics letters.

[9]  Tadataka Yamada,et al.  Textbook of Gastroenterology , 1995 .

[10]  Gregory Zuccaro,et al.  Optical coherence tomography in the gastrointestinal tract. , 2004, Gastrointestinal endoscopy clinics of North America.

[11]  W. Koltun,et al.  Indeterminate colitis predisposes to perineal complications after ileal pouch-anal anastomosis , 1991, Diseases of the colon and rectum.

[12]  A. Margulis,et al.  The overlapping spectrum of ulcerative and granulomatous colitis: a roentgenographic-pathologic study. , 1971, The American journal of roentgenology, radium therapy, and nuclear medicine.

[13]  C. Delaney,et al.  Equivalent Function, Quality of Life and Pouch Survival Rates After Ileal Pouch-Anal Anastomosis for Indeterminate and Ulcerative Colitis , 2002, Annals of surgery.

[14]  J. Fujimoto,et al.  Optical biopsy and imaging using optical coherence tomography , 1995, Nature Medicine.

[15]  R. Beart,et al.  Indeterminate colitis , 1995, Diseases of the colon and rectum.

[16]  G. Gelikonov,et al.  In vivo endoscopic OCT imaging of precancer and cancer states of human mucosa. , 1997, Optics express.

[17]  V. Fazio,et al.  Histologic Changes in Defunctioned Rectums in Patients With Inflammatory Bowel Disease , 2002, Diseases of the colon and rectum.

[18]  P. Schofield,et al.  Diagnosis of inflammatory bowel disease. , 1978, British medical journal.

[19]  D. Owen,et al.  Restorative proctocolectomy and indeterminate colitis. , 1994, American journal of surgery.

[20]  J. Fujimoto,et al.  Optical Coherence Tomography , 1991 .

[21]  Gregory Zuccaro,et al.  Ex vivo histology-correlated optical coherence tomography in the detection of transmural inflammation in Crohn's disease. , 2004, Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association.

[22]  J. Kirsner.  Problems in the differentiation of ulcerative colitis and Crohn's disease of the colon: the need for repeated diagnostic evaluation. , 1975, Gastroenterology.

[23]  J. Izatt,et al.  High-resolution endoscopic imaging of the GI tract using optical coherence tomography. , 2000, Gastrointestinal endoscopy.

[24]  C K Hitzenberger,et al.  Mêasurement of corneal thickness by low-coherence interferometry. , 1992, Applied optics.

[25]  M. Tada,et al.  Endoscopic ultrasonography in inflammatory bowel diseases. , 1995, Gastrointestinal endoscopy clinics of North America.

[26]  J. Belaïche,et al.  Rectal Endosonography in Inflammatory Bowel Disease: Differential Diagnosis and Prediction of Remission , 1999, Endoscopy.

[27]  A. Price.  Overlap in the spectrum of non-specific inflammatory bowel disease--'colitis indeterminate'. , 1978, Journal of clinical pathology.

[28]  E A Swanson,et al.  Optical biopsy with optical coherence tomography: feasibility for surgical diagnostics. , 1997, The Journal of surgical research.

[29]  M. Tada,et al.  Value of Endoscopic Ultrasonography in the Assessment of Inflammatory Bowel Diseases , 1992, Endoscopy.

[30]  E. Swanson,et al.  Optical Coherence Tomography , 1992, LEOS '92 Conference Proceedings.

[31]  D. Podolsky,et al.  Inflammatory bowel disease (1) , 1991, The New England journal of medicine.

[32]  R. Farmer,et al.  Clinical patterns in Crohn's disease: a statistical study of 615 cases. , 1975, Gastroenterology.

[33]  S. Hanauer,et al.  Advanced Therapy of Inflammatory Bowel Disease , 2000 .

[34]  V Westphal,et al.  High-resolution endoscopic imaging of the GI tract: a comparative study of optical coherence tomography versus high-frequency catheter probe EUS. , 2001, Gastrointestinal endoscopy.

[35]  G. Feifel,et al.  Endosonographic Differentiation of Mucosal and Transmural Nonspecific Inflammatory Bowel Disease , 1992, Endoscopy.

[36]  J. Church,et al.  IIeal Pouch‐Anal Anastomoses Complications and Function in 1005 Patients , 1995, Annals of surgery.

[37]  Elena V. Zagaynova,et al.  Optical coherence tomography of the esophagus and proximal stomach in health and disease , 2001 .

[38]  C. Compton,et al.  High-resolution imaging of the human esophagus and stomach in vivo using optical coherence tomography. , 2000, Gastrointestinal endoscopy.