Discordance between endoscopic and histopathologic assessment in ileal Crohn’s disease  

作　　者：Scott D Lee Brian Mau Cody J Avalos Kindra D Clark-Snustad Kendra J Kamp Xianyong Gui 

机构地区：[1]Department of Gastroenterology,School of Medicine,University of Washington,Seattle,WA 98195,United States [2]Department of Pathology and Laboratory Medicine,Oregon Health and Science University,Portland,OR 97239,United States [3]Department of Biobehavioral Nursing and Health Informatics,University of Washington,Seattle,WA 98195,United States [4]Department of Pathology,Wake Forest University School of Medicine Bowman Gray Center for Medical Education,Winston-Salem,NC 27101,United States [5]Department of Laboratory Medicine and Pathology,University of Washington,Seattle,WA 98195,United States

出　　处：《World Journal of Gastrointestinal Endoscopy》2025年第2期48-54,共7页世界胃肠内镜杂志(英文)

摘　　要：BACKGROUND Discordance between endoscopic and histologic assessments in Crohn’s disease(CD)have been observed,however the prevalence and cause are unclear.AIM To assess if a protocolized approach to biopsy collection facilitates understanding of this discordance in patients with ileal CD.METHODS Patients with known ileal CD underwent colonoscopy with endoscopic disease activity assessment.Three protocolized biopsies were taken respectively from an ulcer edge,7-mm,and 14-mm away from the ulcer edge in patients with discrete ileal ulcer(s).In patients with no ulcers as controls,the same 3-site biopsy protocol was applied in a randomly selected area of endoscopically-unremarkable terminal ileal mucosa.A blinded pathologist assessed mucosal inflammation in each biopsy using 3 validated histologic indices.RESULTS Twenty-four participants had visible ulcer(s)on endoscopy and 12 served as no-ulcer controls.Of biopsies taken from an ulcer edge,only 67%showed histologic evidence of active(neutrophilic)inflammation,and 33%showed histologic features of ulcer or erosion;all were from either large(n=4)or very large(n=4)ulcers.In the no-ulcer controls,no biopsies showed histologic features of ulcer or erosion,but 8%showed active inflammation.CONCLUSION A striking discordance exists between endoscopic and histologic assessments for mucosal inflammation in patients with active ileal CD,even in biopsies targeted at an ulcer edge,while a higher concordance is seen in patients with no endoscopic disease activity.It remains unclear how to incorporate histologic disease activity into the treatment paradigm.Further research is needed to optimize biopsy protocols and histologic assessments for CD.

关 键 词：Crohn’s disease ENDOSCOPY HISTOLOGY DISCORDANCE BIOPSY 

分 类 号：R57[医药卫生—消化系统]