Received: 31.10.2011 Accepted: 11.11.2011 J Gastrointestin Liver Dis December 2011 Vol. 20 No 4, 423-426 Address for correspondence: Cristian Gheorghe, MD, PhD Center of Gastroenterology Fundeni Clinical Institute for Digestive Diseases and Liver Transplantation Bucharest, Romania Email: drgheorghe@xnet.ro Endomicroscopy for Assessing mucosal healing in Patients with ulcerative Colitis Cristian Gheorghe, Bogdan Cotruta, Razvan Iacob, Gabriel Becheanu, Mona Dumbrava, Liana Gheorghe Center for Digestive Diseases and Liver Transplantation, Fundeni Clinical Institute, Bucharest, Romania Abstract The assessment of tissue healing has emerged as an important treatment goal in patients with inlammatory bowel disease. In patients with ulcerative colitis (UC), mucosal healing may represent the ultimate therapeutic goal due to the fact that the inlammation is limited to the mucosal layer. Mucosal and histological healing may indicate a subset of UC patients in long-term clinical, endoscopic and histological remission in whom immunomodulators, biologics, and even aminosalicylates may be withdrawn. Confocal laser endomicroscopy allows the assessment of residual cellular inlammation, crypt and vessel architecture distortion during ongoing endoscopy, and therefore permits a real-time evaluation of histological healing in patients with ulcerative proctitis. Images of conventional optical microscopy and confocal laser endomicroscopy in patients with ulcerative proctitis in remission are presented. Key words Endomicroscopy – mucosal healing – ulcerative colitis. Introduction The assessment of tissue healing has emerged as an important treatment goal in patients with inlammatory bowel disease (IBD). It is associated with sustained clinical remission and reduces the rates of hospitalization and surgical resection, as well as the direct and indirect costs [1]. In patients with ulcerative colitis (UC), mucosal healing (MH) may represent the ultimate therapeutic goal due to the limited inlammation to the mucosal layer. Several endoscopic scoring systems have been developed using CLINICAL ImAGING different items and deinitions of MH. The easiest to use are the modiied Baron score and the Mayo score [2, 3]. The endoscopic variables for the Baron score are friability, vascular pattern, bleeding, and ulcerations assessed by using a 5-points scale (from 0 to 4). Endoscopic variables of the Mayo score are erythema, vascular pattern, friability, bleeding, erosions and ulcerations, assessed with a 4-point scale (from 0 to 3); MH is deined by a score of 0 and 1. The weakness of these scores is the lack of discrimination between supericial and deep ulcerations. The Baron score, distinguishing three grades of activity, has been commonly used to evaluate the degree of endoscopic activity. Recently, the FDA recommended considering any friability as non- healed mucosa [4]. In 2007, the International Organization of IBD proposed a deinition of MH in UC: the absence of friability, blood, erosions, and ulcers in all visualized segments of the gut mucosa [5]. Although total MH means, in theory, no visible lesions at all, the experts concluded that an abnormal vascular pattern, in the absence of the other features of the disease, is still compatible with MH [1]. Finally, MH may be used as ultimate therapeutic goal to select patients in whom stopping immunosuppressive or biologic therapy could be considered [1]. Moreover, there are experts who promote the concept of histological healing (HH) in patients with UC in remission and MH to characterize complete recovery of the colonic mucosa [1]. Histological healing means either absence of residual mucosal inlammation with distinctive changes of crypt architectural distortion and/or atrophy, or entirely normal mucosa [6]. Histological assessment of UC is inseparable from colonoscopic investigation and biopsy in current clinical practice. The assessment of inlammation activity by conventional colonoscopy is inaccurate in the prediction of acute inlammation in some cases, especially for those seeming to be in remission as evaluated by conventional colonoscopy. Histological assessment of inflammation in UC includes acute inflammatory cell iniltrates (polymorphonuclear cells in the lamina propria), crypt abscesses, mucin depletion, surface epithelial integrity, chronic inlammatory cell iniltrates (lympho-plasmocyte cells in the lamina propria) and crypt architectural irregularities