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‘Second-look’ sigmoidoscopy helps predict colectomy rate in acute severe UC
Patients hospitalized for acute severe ulcerative colitis who show endoscopic improvement after undergoing a second sigmoidoscopy have lower rates of colectomy, according to research published in Inflammatory Bowel Diseases.
Ashwin N. Ananthakrishnan, MD, MPH, of the division of gastroenterology at Massachusetts General Hospital, and colleagues wrote that these “second-look” sigmoidoscopies could play a role in the complex management of patients with acute severe UC (ASUC).
“Accurately predicting which patients are failing to respond to intravenous corticosteroids or medical rescue therapy and would need a colectomy is challenging,” they wrote. “Although many predictive models have been developed, few have incorporated dynamic changes in objective disease severity, and those relying on biochemical changes are only of moderate value.”
Ananthakrishnan and colleagues analyzed data from 49 patients (mean age 42 years; 52% women) who underwent two sigmoidoscopy procedures during the same index hospitalization for ASUC. The aim of their study was to identify predictors of improvement during the second endoscopic procedure and examine the independent effect of the improvement on colectomy rates in-hospital, as well as after 3, 6 and 12 months.
Investigators found that 30% of patients experienced endoscopic improvement at the time of the second sigmoidoscopy. Of these patients, none underwent in-hospital colectomy compared with 46% of patients with worsening or persistent disease (P = .002). Researchers noted a similar difference at 3 (P = .007) and 6 months (P = .027).
Ananthakrishnan and colleagues wrote that their findings show that there might be value in repeat sigmoidoscopy in patients hospitalized for ASUC.
“Our findings suggest that a second-look endoscopy may have value in a subset of patients with ASUC, identifying those who demonstrate early endoscopic improvement even in the setting of non-improvement of symptoms,” they wrote. “Such patients may be at a lower short- and medium-term risk of colectomy and could potentially benefit from escalation of medical therapy.” – by Alex Young
Disclosures: Ananthakrishnan has served on advisory boards for AbbVie, Merck and Takeda. All other authors report no relevant financial disclosures.