PICaSSO score: a useful endoscopic tool in ulcerative colitis, Finds study

Researchers have noted that Paddington International Virtual ChromoendoScopy ScOre (PICaSSO) score predicted specified clinical outcomes at 6 and 12 months, and can be a useful endoscopic tool in the therapeutic management of UC.

The study is published in the Journal of Gastroenterology.

Endoscopic and histologic remission are important goals in the treatment of ulcerative colitis (UC). Hence, Marietta Iacucci and colleagues from the

Institute of Immunology and Immunotherapy, NIHR Wellcome Trust Clinical Research Facilities, University of Birmingham, and University Hospitals Birmingham NHS Trust, Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, United Kingdom and the Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Canada carried out the present study to investigate the correlation of the recently developed Paddington International Virtual ChromoendoScopy ScOre (PICaSSO) and other established endoscopic scores against multiple histological indices and prospectively assessed outcomes.

In this prospective multicenter international study, a total of 307 patients were recruited, and their inflammatory activity was assessed with high-definition and virtual chromoendoscopy in the rectum and sigmoid using the Mayo Endoscopic Score (MES), UC Endoscopic Index of Severity (UCEIS), and PICaSSO.

Targeted biopsies were taken for the assessment using Robarts Histological Index (RHI), Nancy Histological index (NHI), ECAP (Extent, Chronicity, Activity, Plus score), Geboes, and Villanacci. Follow-up data were obtained at 6 and 12 months after colonoscopy.

The following results were seen-

a. There was a strong correlation between PICaSSO and histology scores, significantly superior to correlation coefficients of MES and UCEIS with histology scores.

b. A PICaSSO score of ≤3 detected histologic remission by RHI (≤3 + absence of neutrophils) with the area under the receiver operating characteristic curve (AUROC) 0.90 (95% confidence interval [CI] 0.86-0.94) and NHI (≤1) AUROC 0.82 (95% CI 0.77-0.87).

c. The interobserver agreement for PICaSSO was 0.88 (95% CI 0.83-0.92).

d. At 6- and 12-months follow-up, PICaSSO score ≤3 predicted better outcomes than PICaSSO >3 (hazard ratio [HR] 0.19 [0.11-0.33] and 0.22 [0.13-0.34], respectively),} as well as PICaSSO 4-8 (HR 0.25 [0.12-0.53] and 0.22 (0.12-0.39), respectively) and similar to histologic remission.

Hence, the authors concluded that "in this first real-life multicenter study, the PICaSSO score correlated strongly with multiple histological indices. Furthermore, PICaSSO score predicted specified clinical outcomes at 6 and 12 months, similar to histology. Thus, PICaSSO can be a useful endoscopic tool in the therapeutic management of UC."