Intest Res.  2016 Oct;14(4):314-321. 10.5217/ir.2016.14.4.314.

Narrow-band imaging with magnifying endoscopy for Peyer's patches is useful in predicting the recurrence of remissive patients with ulcerative colitis

• Hiyama S
• Iijima H
• Kawai S
• Mukai A
• Shiraishi
• Iwatani S
• Yamaguchi
• Araki M
• Hayashi Y
• Shinzaki S
• Mizushima
• Tsujii M
• Takehara T

• KMID: 2354949
• DOI: http://doi.org/10.5217/ir.2016.14.4.314

Abstract

BACKGROUND/AIMS
Peyer's patches (PPs) are aggregates of lymphoid follicles that are mainly located in the distal ileum; they play a major role in mucosal immunity. We recently reported that patients with ulcerative colitis (UC) have alterations in PPs that can be detected using narrow-band imaging with magnifying endoscopy (NBI-ME). However, the usefulness of NBI-ME in UC treatment as a whole is still unknown.
METHODS
We collected NBI-ME images of PPs from 67 UC patients who had undergone ileocolonoscopy. We evaluated changes in the villi using the "villi index," which is based on three categories: irregular formation, hyperemia, and altered vascular network pattern. The patients were divided into two groups on the basis of villi index: low (L)- and high (H)-types. We then determined the correlation between morphological alteration of the PPs and various clinical characteristics. In 52 patients who were in clinical remission, we also analyzed the correlation between NBI-ME findings of PPs and clinical recurrence.
RESULTS
The time to clinical recurrence was significantly shorter in remissive UC patients with H-type PPs than in those with L-type PPs (P<0.01). Moreover, PP alterations were not correlated with age, sex, disease duration, clinical activity, endoscopic score, or extent of disease involvement. Multivariate analysis revealed that the existence of H-type PPs was an independent risk factor for clinical recurrence (hazard ratio, 3.3; P<0.01).
CONCLUSIONS
UC patients with morphological alterations in PPs were at high risk of clinical relapse. Therefore, to predict the clinical course of UC, it may be useful to evaluate NBI-ME images of PPs.

Keyword

Colitis, ulcerative; Peyer's patch; Narrow-band imaging

MeSH Terms

Colitis, Ulcerative*
Endoscopy*
Humans
Hyperemia
Ileum
Immunity, Mucosal
Multivariate Analysis
Peyer's Patches*
Recurrence*
Risk Factors
Ulcer*

Figure

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  Fig. 1 Narrow-band imaging with magnifying endoscopy allowed us to clearly observe Peyer's patches: aggregates of multiple domes (d) surrounded by villi (v) with semi-circular vessels.

• 

  Fig. 2 (A) Scatterplot of the villi index against Mayo endoscopic subscore at the colonoscopy. No correlation was seen between the villi index and the Mayo endoscopic subscore. Bars represent the mean. Representative images of L-type (B) and H-type (C) Peyer's patches (PPs) (black arrows, irregular formation; white arrow, hyperemia; arrowheads, altered vascular network pattern). (D) Evaluation of PPs by narrow-band imaging with magnifying endoscopy in UC patients using the "villi index." Thirty-five patients showed L-type PPs (villi index, 0 or 1), while 32 showed H-type PPs (villi index, 2 or 3). (E) A representative image of the reddish peri-appendiceal mucosa in patients with UC. H-type, high-type; L-type, low-type.

• 

  Fig. 3 Results of the Kaplan-Meier survival analysis showing the cumulative proportion of patients who experienced clinical recurrence based on Peyer's patch imaging using narrow-band imaging with magnifying endoscopy (A) and Mayo endoscopic subscore (B). H-type, high-type; L-type, low-type.

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