Endocytoscopic intramucosal capillary network changes and crypt architecture abnormalities can predict relapse in patients with an ulcerative colitis Mayo endoscopic score of 1

Objectives Recent studies have suggested the necessity of therapeutic intervention for patients with ulcerative colitis at high risk of clinical relapse with a Mayo endoscopic score (MES) of 1. The aim of this retrospective cohort study was to demonstrate the impact of intramucosal capillary network changes and crypt architecture abnormalities to stratify the risk of relapse in patients with an MES of 1. Methods All included patients had an MES of ≤1 and confirmed sustained clinical remission between October 2016 and April 2019. We classified patients with an MES of 1 as “intramucosal capillary/crypt (ICC)‐active” or “ICC‐inactive” using endocytoscopic evaluation. We followed patients until October 2019 or until relapse; the main outcome measure was the difference in clinical relapse‐free rates between ICC‐active and ICC‐inactive patients with an MES of 1. Results We included 224 patients and analyzed data for 218 (82 ICC‐active and 54 ICC‐active with an MES of 1 and 82 with an MES of 0). During follow‐up, among the patients with an MES of 1, 30.5% (95% confidence interval 20.8–41.6; 25/82) of the patients relapsed in the ICC‐active group and 5.6% (95% confidence interval 1.2–15.4; 3/54) of the patients relapsed in the ICC‐inactive group. The ICC‐inactive group had a significantly higher clinical relapse‐free rate compared with the ICC‐active group ( P < 0.01). Conclusions In vivo intramucosal capillary network and crypt architecture patterns stratified the risk of clinical relapse in patients with an MES of 1 (UMIN 000032580; UMIN 000036359).