Endocytoscopy with automated multispectral intestinal barrier pathology imaging for assessment of deep healing to predict outcomes in ulcerative colitis

MESSAGE

Barrier healing represents a novel therapeutic target in ulcerative colitis (UC), although its assessment remains challenging and lacks standardisation. This exploratory study evaluates the ability of ultra-high magnification endocytoscopy to guide tissue sampling and drive automated quantification of tight junction (TJ) proteins to assess intestinal barrier integrity and predict major adverse outcomes (MAOs). 34 UC patients in clinical remission prospectively underwent assessment with endocytoscopy and machine learning-enabled intestinal barrier protein evaluation. The combination of endocytoscopy with Claudin-2 expression showed promise in accurately predicting MAOs over 12 months. This integrative approach holds promise in identifying deep healing and enhancing treat-to-target strategy in UC.