Novel endoscopic scoring system for immune mediated colitis: a multicenter retrospective study of 674 patients

Yinghong Wang; Hamzah Abu-Sbeih; Tenglong Tang; Malek Shatila; David Faleck; Jessica Harris; Michael Dougan; Anna Olsson-Brown; Douglas B Johnson; Chanjuan Shi; Petros Grivas; Leonidas Diamantopoulos; Dwight H Owen; Clarissa Cassol; Christina A Arnold; David E Warner; Ajjai Alva; Nick Powell; Hajir Ibraheim; Enrico N De Toni; Alexander B Philipp; Jessica Philpott; Joseph Sleiman; Mark Lythgoe; Ella Daniels; Shahneen Sandhu; Alison M Weppler; Andrew Buckle; David J Pinato; Anusha Thomas; Wei Qiao

doi:10.1016/j.gie.2024.01.024

Novel endoscopic scoring system for immune mediated colitis: a multicenter retrospective study of 674 patients

Yinghong Wang
, Hamzah Abu-Sbeih
, Tenglong Tang
, Malek Shatila
, David Faleck
, Jessica Harris
, Michael Dougan
, Anna Olsson-Brown
, Douglas B Johnson
, Chanjuan Shi
, Petros Grivas
, Leonidas Diamantopoulos
, Dwight H Owen
, Clarissa Cassol
, Christina A Arnold
, David E Warner
, Ajjai Alva
, Nick Powell
, Hajir Ibraheim
, Enrico N De Toni

Alexander B Philipp, Jessica Philpott, Joseph Sleiman, Mark Lythgoe, Ella Daniels, Shahneen Sandhu, Alison M Weppler, Andrew Buckle, David J Pinato, Anusha Thomas, Wei Qiao

Cork University Dental School and Hospital

The University of Texas MD Anderson Cancer Center
University of Missouri
Memorial Sloan-Kettering Cancer Center
Massachusetts General Hospital
Vanderbilt University Medical Center
University of Washington
The Ohio State University
University of Michigan, Ann Arbor
Royal Marsden Hospital Chelsea
LMU University Hospital Munich
Copenhagen Center for Inflammatory Bowel Disease in Children
University of Pittsburgh Medical Center
Imperial College London
Chelsea and Westminster Hospital NHS Foundation Trust
Peter Maccallum Cancer Centre
University of Piemonte Orientale

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND AND AIMS: No endoscopic scoring system has been established for immune-mediated colitis (IMC). This study aimed to establish such a system for IMC and explore its utility in guiding future selective immunosuppressive therapy (SIT) use compared to clinical symptoms.

METHODS: This retrospective, international, 14-center study included 674 patients who developed IMC after immunotherapy and underwent endoscopic evaluation. Ten endoscopic features were selected by group consensus and assigned 1 point each to calculate an IMC endoscopic score (IMCES). IMCES cutoffs were chosen to maximize specificity for SIT use. This specificity was compared between IMCESs, and clinical symptoms were graded according to a standardized instrument.

RESULTS: A total of 309 (45.8%) patients received SIT. IMCES specificity for SIT use was 82.8% with a cutoff of 4. The inclusion of ulceration as a mandatory criterion resulted in higher specificity (85.0% for a cutoff of 4). In comparison, the specificity of a Mayo endoscopic subscore of 3 was 74.6%, and the specificity of clinical symptom grading was much lower at 27.4% and 12.3%, respectively. Early endoscopy was associated with timely SIT use (P < .001; r = 0.4084).

CONCLUSIONS: This is the largest multicenter study to devise an endoscopic scoring system to guide IMC management. An IMCES cutoff of 4 has a higher specificity for SIT use than clinical symptoms, supporting early endoscopic evaluation for IMC.

Original language	English
Pages (from-to)	273-282.e4
Journal	Gastrointestinal Endoscopy
Volume	100
Issue number	2
DOIs	https://doi.org/10.1016/j.gie.2024.01.024
Publication status	Published - Aug 2024

Keywords

Adult
Aged
Colitis/pathology
Colonoscopy/methods
Female
Humans
Immunosuppressive Agents/therapeutic use
Immunotherapy/methods
Male
Middle Aged
Retrospective Studies
Sensitivity and Specificity
Severity of Illness Index
Ulcer/pathology

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10.1016/j.gie.2024.01.024

Cite this

Wang, Y., Abu-Sbeih, H., Tang, T., Shatila, M., Faleck, D., Harris, J., Dougan, M., Olsson-Brown, A., Johnson, D. B., Shi, C., Grivas, P., Diamantopoulos, L., Owen, D. H., Cassol, C., Arnold, C. A., Warner, D. E., Alva, A., Powell, N., Ibraheim, H., ... Qiao, W. (2024). Novel endoscopic scoring system for immune mediated colitis: a multicenter retrospective study of 674 patients. Gastrointestinal Endoscopy, 100(2), 273-282.e4. https://doi.org/10.1016/j.gie.2024.01.024

@article{485d7ac26d394877be7de67684072e1f,

title = "Novel endoscopic scoring system for immune mediated colitis: a multicenter retrospective study of 674 patients",

abstract = "BACKGROUND AND AIMS: No endoscopic scoring system has been established for immune-mediated colitis (IMC). This study aimed to establish such a system for IMC and explore its utility in guiding future selective immunosuppressive therapy (SIT) use compared to clinical symptoms.METHODS: This retrospective, international, 14-center study included 674 patients who developed IMC after immunotherapy and underwent endoscopic evaluation. Ten endoscopic features were selected by group consensus and assigned 1 point each to calculate an IMC endoscopic score (IMCES). IMCES cutoffs were chosen to maximize specificity for SIT use. This specificity was compared between IMCESs, and clinical symptoms were graded according to a standardized instrument.RESULTS: A total of 309 (45.8\%) patients received SIT. IMCES specificity for SIT use was 82.8\% with a cutoff of 4. The inclusion of ulceration as a mandatory criterion resulted in higher specificity (85.0\% for a cutoff of 4). In comparison, the specificity of a Mayo endoscopic subscore of 3 was 74.6\%, and the specificity of clinical symptom grading was much lower at 27.4\% and 12.3\%, respectively. Early endoscopy was associated with timely SIT use (P < .001; r = 0.4084).CONCLUSIONS: This is the largest multicenter study to devise an endoscopic scoring system to guide IMC management. An IMCES cutoff of 4 has a higher specificity for SIT use than clinical symptoms, supporting early endoscopic evaluation for IMC.",

keywords = "Adult, Aged, Colitis/pathology, Colonoscopy/methods, Female, Humans, Immunosuppressive Agents/therapeutic use, Immunotherapy/methods, Male, Middle Aged, Retrospective Studies, Sensitivity and Specificity, Severity of Illness Index, Ulcer/pathology",

author = "Yinghong Wang and Hamzah Abu-Sbeih and Tenglong Tang and Malek Shatila and David Faleck and Jessica Harris and Michael Dougan and Anna Olsson-Brown and Johnson, \{Douglas B\} and Chanjuan Shi and Petros Grivas and Leonidas Diamantopoulos and Owen, \{Dwight H\} and Clarissa Cassol and Arnold, \{Christina A\} and Warner, \{David E\} and Ajjai Alva and Nick Powell and Hajir Ibraheim and \{De Toni\}, \{Enrico N\} and Philipp, \{Alexander B\} and Jessica Philpott and Joseph Sleiman and Mark Lythgoe and Ella Daniels and Shahneen Sandhu and Weppler, \{Alison M\} and Andrew Buckle and Pinato, \{David J\} and Anusha Thomas and Wei Qiao",

year = "2024",

month = aug,

doi = "10.1016/j.gie.2024.01.024",

language = "English",

volume = "100",

pages = "273--282.e4",

journal = "Gastrointestinal Endoscopy",

issn = "0016-5107",

publisher = "Elsevier Inc.",

number = "2",

}

Wang, Y, Abu-Sbeih, H, Tang, T, Shatila, M, Faleck, D, Harris, J, Dougan, M, Olsson-Brown, A, Johnson, DB, Shi, C, Grivas, P, Diamantopoulos, L, Owen, DH, Cassol, C, Arnold, CA, Warner, DE, Alva, A, Powell, N, Ibraheim, H, De Toni, EN, Philipp, AB, Philpott, J, Sleiman, J, Lythgoe, M, Daniels, E, Sandhu, S, Weppler, AM, Buckle, A, Pinato, DJ, Thomas, A & Qiao, W 2024, 'Novel endoscopic scoring system for immune mediated colitis: a multicenter retrospective study of 674 patients', Gastrointestinal Endoscopy, vol. 100, no. 2, pp. 273-282.e4. https://doi.org/10.1016/j.gie.2024.01.024

TY - JOUR

T1 - Novel endoscopic scoring system for immune mediated colitis

T2 - a multicenter retrospective study of 674 patients

AU - Wang, Yinghong

AU - Abu-Sbeih, Hamzah

AU - Tang, Tenglong

AU - Shatila, Malek

AU - Faleck, David

AU - Harris, Jessica

AU - Dougan, Michael

AU - Olsson-Brown, Anna

AU - Johnson, Douglas B

AU - Shi, Chanjuan

AU - Grivas, Petros

AU - Diamantopoulos, Leonidas

AU - Owen, Dwight H

AU - Cassol, Clarissa

AU - Arnold, Christina A

AU - Warner, David E

AU - Alva, Ajjai

AU - Powell, Nick

AU - Ibraheim, Hajir

AU - De Toni, Enrico N

AU - Philipp, Alexander B

AU - Philpott, Jessica

AU - Sleiman, Joseph

AU - Lythgoe, Mark

AU - Daniels, Ella

AU - Sandhu, Shahneen

AU - Weppler, Alison M

AU - Buckle, Andrew

AU - Pinato, David J

AU - Thomas, Anusha

AU - Qiao, Wei

PY - 2024/8

Y1 - 2024/8

N2 - BACKGROUND AND AIMS: No endoscopic scoring system has been established for immune-mediated colitis (IMC). This study aimed to establish such a system for IMC and explore its utility in guiding future selective immunosuppressive therapy (SIT) use compared to clinical symptoms.METHODS: This retrospective, international, 14-center study included 674 patients who developed IMC after immunotherapy and underwent endoscopic evaluation. Ten endoscopic features were selected by group consensus and assigned 1 point each to calculate an IMC endoscopic score (IMCES). IMCES cutoffs were chosen to maximize specificity for SIT use. This specificity was compared between IMCESs, and clinical symptoms were graded according to a standardized instrument.RESULTS: A total of 309 (45.8%) patients received SIT. IMCES specificity for SIT use was 82.8% with a cutoff of 4. The inclusion of ulceration as a mandatory criterion resulted in higher specificity (85.0% for a cutoff of 4). In comparison, the specificity of a Mayo endoscopic subscore of 3 was 74.6%, and the specificity of clinical symptom grading was much lower at 27.4% and 12.3%, respectively. Early endoscopy was associated with timely SIT use (P < .001; r = 0.4084).CONCLUSIONS: This is the largest multicenter study to devise an endoscopic scoring system to guide IMC management. An IMCES cutoff of 4 has a higher specificity for SIT use than clinical symptoms, supporting early endoscopic evaluation for IMC.

AB - BACKGROUND AND AIMS: No endoscopic scoring system has been established for immune-mediated colitis (IMC). This study aimed to establish such a system for IMC and explore its utility in guiding future selective immunosuppressive therapy (SIT) use compared to clinical symptoms.METHODS: This retrospective, international, 14-center study included 674 patients who developed IMC after immunotherapy and underwent endoscopic evaluation. Ten endoscopic features were selected by group consensus and assigned 1 point each to calculate an IMC endoscopic score (IMCES). IMCES cutoffs were chosen to maximize specificity for SIT use. This specificity was compared between IMCESs, and clinical symptoms were graded according to a standardized instrument.RESULTS: A total of 309 (45.8%) patients received SIT. IMCES specificity for SIT use was 82.8% with a cutoff of 4. The inclusion of ulceration as a mandatory criterion resulted in higher specificity (85.0% for a cutoff of 4). In comparison, the specificity of a Mayo endoscopic subscore of 3 was 74.6%, and the specificity of clinical symptom grading was much lower at 27.4% and 12.3%, respectively. Early endoscopy was associated with timely SIT use (P < .001; r = 0.4084).CONCLUSIONS: This is the largest multicenter study to devise an endoscopic scoring system to guide IMC management. An IMCES cutoff of 4 has a higher specificity for SIT use than clinical symptoms, supporting early endoscopic evaluation for IMC.

KW - Adult

KW - Aged

KW - Colitis/pathology

KW - Colonoscopy/methods

KW - Female

KW - Humans

KW - Immunosuppressive Agents/therapeutic use

KW - Immunotherapy/methods

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Sensitivity and Specificity

KW - Severity of Illness Index

KW - Ulcer/pathology

UR - https://www.scopus.com/pages/publications/85196046283

U2 - 10.1016/j.gie.2024.01.024

DO - 10.1016/j.gie.2024.01.024

M3 - Article

C2 - 38272276

SN - 0016-5107

VL - 100

SP - 273-282.e4

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

IS - 2

ER -

Novel endoscopic scoring system for immune mediated colitis: a multicenter retrospective study of 674 patients

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Keywords

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