Researchers at the University of Birmingham have developed and validated a new electronic virtual chromoendoscopy score that could reflect the full spectrum of mucosal and vascular changes, including mucosal healing in ulcerative colitis.  

Mucosal healing in ulcerative colitis is an important therapeutic goal to prevent complications, hospitalisation and surgery, and to improve clinical outcomes for patients. At present, the activity of inflammation in ulcerative colitis is assessed using white light standard endoscopy (WLE). Numerous endoscopic scoring systems have been developed but have many limitations because they cannot distinguish between mild, patchy inflammation and mucosal healing.


Moving beyond the conventional WLE, University of Birmingham gastroenterologists aimed to develop a new electronic virtual chromoendoscopy score (EVC), which was more comprehensive in including details of subtle vascular and mucosal changes reflecting chronic and acute inflammation in ulcerative colitis patients using HD equipment with EVC.

Study lead Dr Marietta Iacucci, a Reader in Gastroenterology based in the Institute of Translational Medicine, explains: ‘We wanted to better define the characteristics of endoscopic mucosal healing in ulcerative colitis patients and therefore we considered and included all the subtle chronic and acute inflammatory changes of vascular and mucosal pattern.

‘We aimed to validate, for the first time, a new PICaSSO score (Paddington International Virtual ChromoendoScopy ScOre), by determining the intraobserver and interobserver agreement among international experts, to assess the correlation with standard endoscopic UC scores and the correlation to several histological scores.'

Eight international experts reviewed a 60-minute training module outlining the three i-SCAN modes demonstrating the entire spectrum of inflammatory mucosal and vascular changes in UC. Performance characteristics in endoscopic scoring and predicting the histologic inflammation with EVC (i-SCAN) by using 20 video clips before (pre-test) and after (post-test) were evaluated. The EVC score “PICaSSO” showed very good interobserver agreement.

The study, newly published online, concludes: ‘The new EVC score may be used to define the endoscopic findings of the mucosal and vascular healing in UC and reflected the full spectrum of histological changes.Previous scoring limitations have been overcome by this new score which relates well to histology.’