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Magnifying endoscopy with crystal violet staining for immune checkpoint inhibitor‐associated colitis
Author(s) -
Inoue Shuntaro,
Kono Mitsuhiro,
Fukuda Hiromu,
Shimamoto Yusaku,
Nakagawa Kentaro,
Ohmori Masayasu,
Iwagami Hiroyoshi,
Matsuno Kenshi,
Iwatsubo Taro,
Nakahira Hiroko,
Matsuura Noriko,
Shichijo Satoki,
Maekawa Akira,
Kanesaka Takashi,
Yamamoto Sachiko,
Takeuchi Yoji,
Higashino Koji,
Uedo Noriya,
Kitamura Masanori,
Nakatsuka Shinichi,
Kunimasa Kei,
Kumagai Toru,
Isei Taiki,
Ishihara Ryu
Publication year - 2021
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.15246
Subject(s) - medicine , biopsy , colitis , crypt , inflammation , colonoscopy , endoscopy , immune system , gastroenterology , staining , pathology , immunology , cancer , colorectal cancer
Abstract Background and Aim There exists no evidence on the relationship between endoscopic and histologic findings. Furthermore, even after multiple biopsy specimens were obtained, histologic examination usually fails to show the characteristic features of immune checkpoint inhibitor‐associated colitis. In this study, we explored the endoscopic and histologic findings of immune checkpoint inhibitor‐associated colitis. Methods Patients diagnosed with immune checkpoint inhibitor‐associated colitis at our hospital between March 2018 and December 2018 were retrospectively assessed. The degree of mucosal inflammation was evaluated using endoscopic inflammation grade (inactive, mild, moderate, or severe disease) and further observed using magnifying endoscopy with crystal violet staining. Pit structures were classified into three types: regularly arranged pits with circular or elliptical shape (R type), irregularly arranged pits with inhomogeneous size and morphology (IR type), and pits with reduced density or pits that partially disappeared (AD type). Results Eleven patients (median age, 71 years; range, 44–83 years) were diagnosed with immune checkpoint inhibitor‐associated colitis. All characteristic histologic findings, including crypt distortion, crypt abscesses, and apoptotic bodies, were observed at sites with moderate‐to‐severe endoscopic inflammation but not at sites with inactive‐to‐mild endoscopic inflammation. Characteristic histologic features were observed in 0%, 50%, and 100% of R‐type, IR‐type, and AD‐type mucosa, respectively. Conclusions We revealed the possible utility of endoscopic images for selecting suitable target sites for biopsy and showed that endoscopic findings could reduce the time lag associated with tissue diagnosis and sampling errors due to biopsy.