Rectoscopy alone may be sufficient to evaluate for remission of ulcerative colitis

1. Rectoscopy alone for evaluation of endoscopic and histologic remission of ulcerative colitis (UC) had good accuracy and is sufficient for use in clinical practice.

Evidence Rating Level: 2 (Good)

In recent years, endoscopic healing has become one of the main treatment targets in UC with studies also showing that histologic healing is associated with better outcomes. International guidelines have proposed use of rectosigmoidoscopy (RS) following initiation of pharmacological management to assess for endoscopic healing, yet acceptability of RS has been limited thus far. This prospective study therefore sought to investigate whether RS and rectoscopy could adequately measure UC activity in the proximal colon. Between January 2021 and January 2023, 80 patients (median[IQR] age, 43[30-57] years) from Amiens University Hospital were included. Endoscopic healing was defined as a Mayo endoscopic score (MES) of 0 and histological healing was defined as a Nancy index less than or equal to 1. 34 of 80 included patients had an MES of 0 on both RS and colonoscopy, while 2 patients showed endoscopic healing on RS but not colonoscopy corresponding to a к index of 0.95 (%-agree 97.5, P < .0001, 0% false positives). Similarly, the agreement between rectoscopy and colonoscopy for assessment of patients with MES of 0 were also nearly perfect with a к index of 0.83 (%-agree 91.2, P < .001, 0% false positive). The agreement between RS and colonoscopy for histological remission was nearly perfect with a к index of 0.94 (%-agree 97.3, P < .001) while the agreement between rectoscopy and colonoscopy for histological remission was similarly nearly perfect with a к index of 0.84 (%-agree 93.1, P < .001). Overall, this study found that rectoscopy alone was sufficient in clinical practice for the evaluation of endoscopic and histological remission in UC. 

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