Is endoscopic examination alone adequate for determining the extent of disease in ulcerative colitis

Abstract

BACKGROUND: Endoscopic and histological examination of the mucosa are the mainstay in the diagnosis of ulcerative colitis. Assessing the extent of disease is important in management of these patients. Sometimes an endoscopic examination alone is performed without biopsy and histological examination. OBJECTIVE: To compare the extent of disease in ulcerative colitis as judged endoscopically versus that determined histologically. METHOD: 27 patients with ulcerative colitis were identified. In each patient the endoscopy was performed and the appearance was recorded in a diagrammatic form. In each patient 1 -6 (Mean 3.8) mucosal biopsies were obtained for histological evaluation. A total of 101 biopsies were examined histologically and compared with the endoscopic appearance of the corresponding area of the bowel as depicted in the diagramme. RESULTS: 93 out of 101 biopsies showed histological involvement. The endoscopy and histology were both positive in 41/101, the endoscopy was negative whilst histology was positive in 52/101, endoscopy and histology were both negative in 7/101, and endoscopy alone was positive in 1/101 biopsies. The Kappa value of agreement of .081 denoted a poor agreement between endoscopy and histology. CONCLUSION: Since the endoscopy and histology show poor agreement it is recommended that both should be performed to assess the true extent of disease in ulcerative colitis.