Intest Res.  2024 Jul;22(3):310-318. 10.5217/ir.2023.00174.

Adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study

• Patel ST
• Jena A
• Chandnani S
• Jain S
• Nawghare P
• Bansal S
• Gandhi H
• Malokar R
• Chudasama J
• Debnath P
• Kahmei S
• Kamat R
• Kini S
• Contractor QQ
• Rathi PM

• KMID: 2558191
• DOI: http://doi.org/10.5217/ir.2023.00174

Abstract

Background/Aims
Patients of ulcerative colitis (UC) on follow-up are routinely evaluated by sigmoidoscopy. There is no prospective literature to support this practice. We assessed agreement between sigmoidoscopy and colonoscopy prospectively in patients with disease extent beyond the sigmoid colon.
Methods
We conducted a prospective observational study at a tertiary care institute for agreement between sigmoidoscopy and colonoscopy. We assessed endoscopic activity using the Mayo Endoscopic Score (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and histological activity using the Nancy Index (NI), Robarts Histopathology Index (RHI), and Simplified Geboes Score (SGS).
Results
Sigmoidoscopy showed a strong agreement with colonoscopy for MES and UCEIS with a kappa (κ) of 0.96 and 0.94 respectively. The misclassification rate for MES and UCEIS was 3% and 5% respectively. Sigmoidoscopy showed perfect agreement (κ = 1.00) with colonoscopy for assessment of the presence of endoscopic activity in the colon using MES ≥ 1 as activity criteria and strong agreement (κ = 0.93) using MES > 1 as activity criteria. Sigmoidoscopy showed strong agreement with colonoscopy for assessment of the presence of endoscopic activity using UCEIS (κ = 0.92). Strong agreement was observed between sigmoidoscopy and colonoscopy using NI (κ = 0.86), RHI (κ = 1.00), and SGS (κ = 0.92) for the detection of histological activity. The misclassification rate for the detection of histological activity was 2%, 0%, and 1% for NI, RHI, and SGS respectively.
Conclusions
Sigmoidoscopy showed strong agreement with colonoscopy for endoscopic and histologic disease activity. Sigmoidoscopy is adequate for assessment of disease activity in patients with UC during follow-up evaluation.

Keyword

Endoscopic score; Disease severity; Biopsy; Inflammatory bowel diseases

Figure

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  Fig. 1. Study flowchart. MES, Mayo Endoscopic Score; UCEIS, Ulcerative Colitis Endoscopic Index of Severity; NI, Nancy Index; RHI, Robarts Histopathology Index; SGS, Simplified Geboes Score.

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  Fig. 2. Area under the curve (AUC) graph showing adequacy of sigmoidoscopy in comparison to colonoscopy using endoscopic scores as criteria for activity. (A) AUC graph showing adequacy of sigmoidoscopy in comparison to colonoscopy using Mayo Endoscopic Score >0 as criteria for activity. (B) AUC graph showing adequacy of sigmoidoscopy in comparison to colonoscopy using Mayo Endoscopic Score >1 as criteria for activity. (C) AUC graph showing adequacy of sigmoidoscopy in comparison to colonoscopy using Ulcerative Colitis Endoscopic Index of Severity >1 as criteria for activity. PPV, positive predictive value; NPV, negative predictive value.

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  Fig. 3. Area under the curve (AUC) graph showing adequacy of sigmoidoscopy in comparison to colonoscopy using histological indices as criteria for activity. (A) AUC graph showing adequacy of sigmoidoscopy in comparison to colonoscopy using Nancy Index for activity. (B) AUC graph showing adequacy of sigmoidoscopy in comparison to colonoscopy using Robarts Histopathology Index for activity. (C) AUC graph showing adequacy of sigmoidoscopy in comparison to colonoscopy using Simplified Geboes Score for activity. PPV, positive predictive value; NPV, negative predictive value.

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