Novel endoscopic scoring system for immune mediated colitis: A Multicenter Retrospective Study of 674 Patients

Yinghong Wang; Hamzah Abu-Sbeih; Tenglong Tang; Malek Shatila; David Faleck; Jessica Harris; Michael Dougan; Anna Olsson-Brown; Douglas B Johnson; Chanjuan Shi; Petros Grivas; Leonidas Diamantopoulos; Dwight H Owen; Clarissa Cassol; Christina A Arnold; David E Warner; Ajjai Alva; Nick Powell; Hajir Ibraheim; Enrico N De Toni; Alexander B Philipp; Jessica Philpott; Joseph Sleiman; Mark Lythgoe; Ella Daniels; Shahneen Sandhu; Alison M Weppler; Andrew Buckle; David J Pinato; Anusha Thomas; Wei Qiao

doi:10.1016/j.gie.2024.01.024

Novel endoscopic scoring system for immune mediated colitis: A Multicenter Retrospective Study of 674 Patients

Gastrointest Endosc. 2024 Jan 23:S0016-5107(24)00043-9. doi: 10.1016/j.gie.2024.01.024. Online ahead of print.

Authors

Yinghong Wang¹, Hamzah Abu-Sbeih², Tenglong Tang³, Malek Shatila⁴, David Faleck⁵, Jessica Harris⁵, Michael Dougan⁶, Anna Olsson-Brown⁷, Douglas B Johnson⁸, Chanjuan Shi⁹, Petros Grivas¹⁰, Leonidas Diamantopoulos¹⁰, Dwight H Owen¹¹, Clarissa Cassol¹², Christina A Arnold¹³, David E Warner¹⁴, Ajjai Alva¹⁴, Nick Powell¹⁵, Hajir Ibraheim¹⁵, Enrico N De Toni¹⁶, Alexander B Philipp¹⁶, Jessica Philpott¹⁷, Joseph Sleiman¹⁸, Mark Lythgoe¹⁹, Ella Daniels²⁰, Shahneen Sandhu²¹, Alison M Weppler²¹, Andrew Buckle²¹, David J Pinato²², Anusha Thomas⁴, Wei Qiao²³

Affiliations

¹ Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030. Electronic address: ywang59@mdanderson.org.
² Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030; Department of Internal Medicine, University of Missouri, Kansas City, MO, USA, 64110.
³ Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030; Department of General Surgery, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
⁴ Department of Gastroenterology, Hepatology and Nutrition, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030.
⁵ Gastroenterology, Hepatology and Nutrition Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA, 10065.
⁶ Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA, 02114.
⁷ The Clatterbridge Cancer Centre, Liverpool, UK, L7 8YA.
⁸ Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA, 37235.
⁹ Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA, 37235.
¹⁰ Department of Medicine, Division of Oncology, University of Washington, Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA, 98109.
¹¹ Division of Medical Oncology, The Ohio State University, Columbus, OH, USA, 43210.
¹² Division of Renal Pathology, The Ohio State University, Columbus, OH, USA, 43210.
¹³ Division of Gastrointestinal and Liver Pathology, The Ohio State University, Columbus, OH, USA, 43210.
¹⁴ Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA, 48109.
¹⁵ Royal Marsden Hospital, and Guy's and St Thomas' Hospital, London, UK, SE1 9RS.
¹⁶ Department of Medicine II, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.
¹⁷ Center for Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, OH, USA, 44195.
¹⁸ Center for Inflammatory Bowel Disease, Cleveland Clinic, Cleveland, OH, USA, 44195; Department of Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA, 15213.
¹⁹ Department of Surgery and Cancer, Imperial College London, London, UK, SW7 2BX.
²⁰ Department of Oncology, Chelsea and Westminster Hospital, London, UK, SW10 9NH.
²¹ Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia, 3000.
²² Department of Surgery and Cancer, Imperial College London, London, UK, SW7 2BX; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy, 28100.
²³ Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA, 77030.

PMID: 38272276
DOI: 10.1016/j.gie.2024.01.024

Abstract

Background & aims: No endoscopic scoring system has been established for immune-mediated colitis (IMC). This study aimed to establish such a system for IMC and explore its utility in guiding future selective immunosuppressive therapy (SIT) use compared to clinical symptoms.

Methods: This retrospective international 14-center study included 674 patients who developed IMC after immunotherapy and underwent endoscopic evaluation. Ten endoscopic features were selected by group consensus and assigned one point each to calculate an IMC endoscopic score (IMCES). IMCES cutoffs were chosen to maximize specificity for SIT use. This specificity was compared between IMCES, and clinical symptoms graded according to a standardized instrument.

Results: A total of 309 (45.8%) patients received SIT. IMCES specificity for SIT use was 82.8% with a cutoff of 4 . The inclusion of ulceration as a mandatory criterion resulted in higher specificity (85.0% for a cutoff of 4). In comparison, the specificity of a Mayo Endoscopy Score (MES) of 3 was 74.6% while specificity of clinical symptom grading was much lower at 27.4% and 12.3% respectively. Early endoscopy was associated with timely SIT use (p<0.001, r=0.4084).

Conclusions: This is the largest, multi-center study to devise an endoscopic scoring system to guide IMC management. An IMCES cutoff 4 has a higher specificity for SIT use than clinical symptoms, supporting early endoscopic evaluation for IMC.

Keywords: Mayo endoscopic subscore; endoscopy; immune checkpoint inhibitors; immune-mediated colitis; selective immunosuppressive therapy.