From January 2012 to December 2018, patients with ulcerative colitis whose disease activity was evaluated through colonoscopy were collected. This retrospective multicenter study was conducted at seven tertiary academic hospitals in the southern region of South Korea. Therefore, this study aimed to analyze patients diagnosed with ulcerative colitis who underwent follow-up colonoscopy to determine whether sigmoidoscopy alone could reflect the degree of inflammation of the entire colon. Therefore, it is questionable whether sigmoidoscopy can reflect the activity of the entire colon. However, in both studies, important variables such as previous disease extent, severity, and rectal topical treatment were not reflected in the results. Two previous studies also reported completely different results. Although most guidelines recommend sigmoidoscopy for endoscopic assessment because of the high risk of perforation in severe inflammation, there is no clear recommendation as to whether sigmoidoscopy or colonoscopy is recommended in most other cases. However, we often encounter more severe lesions in the proximal than the rectosigmoid area in clinical practice.

The Mayo Endoscopic Subscore (MES) or Ulcerative Colitis Endoscopic Index of Severity (UCEIS) is most commonly used for the evaluation of endoscopic activity, and the most active site reflects the overall score. Recently, the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE-II) consensus statements reported that endoscopic healing is a long-term target and that assessment can be achieved by sigmoidoscopy or colonoscopy. Endoscopic remission has been suggested as the main treatment goal to prevent permanent intestinal damage and disability. Treatment strategies for ulcerative colitis are shifting from simple symptom control to complete remission of the disease itself. However, colonoscopy should be considered in patients with previous extensive colitis. Therefore, sigmoidoscopy is considered a sufficient substitute for colonoscopy. Sigmoidoscopy and colonoscopy showed a high concordance rate. In 38 cases (7.6%) of patients with a higher MES in the proximal area, it was significantly higher in patients with previous extensive colitis. Endoscopic healing (MES = 0) also showed a high concordance rate. Comparison of active disease (MES ≥ 2) in the rectosigmoid area and the entire colon showed a high concordance rate.

Only in 7.6% and 8.6% of cases, MES and UCEIS scored more severely in the proximal colon. ResultsĪ total of 500 colonoscopic examinations from 333 patients were enrolled. Concordance was evaluated by comparing the highest MES and UCEIS in the rectosigmoid and proximal regions to confirm the usefulness of sigmoidoscopy. Endoscopic disease activity was scored using the Mayo endoscopic subscore (MES) and Ulcerative Colitis Endoscopic Index of Severity (UCEIS) for each segment from the colonoscopy images. We retrospectively analyzed the medical records and endoscopic results of patients with ulcerative colitis followed by colonoscopy in seven tertiary hospitals between January 2012 and December 2018. Whether sigmoidoscopy alone is sufficient to evaluate the disease activity in ulcerative colitis lacks studies. Endoscopic assessment of disease activity is a key parameter in the management of ulcerative colitis.

Uc colonoscopy findings