Characteristics of the Mucosal Surface on Scanning Electron Microscopy in Patients with Remitting Ulcerative Colitis
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ORIGINAL ARTICLE
Characteristics of the Mucosal Surface on Scanning Electron Microscopy in Patients with Remitting Ulcerative Colitis Ena Nomura1 · Tomohisa Sujino1 · Naoki Hosoe2 · Yusuke Yoshimatsu1 · Shun Tanemoto1 · Kaoru Takabayashi2 · Makoto Mutaguchi2 · Masayuki Shimoda3 · Makoto Naganuma1 · Haruhiko Ogata2 · Takanori Kanai1 Received: 11 June 2020 / Accepted: 7 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background Ulcerative colitis (UC) is characterized by chronic intestinal epithelial damage, and previous studies have evaluated the epithelial structure of patients with active UC using electron microscopy. Aims This study aimed to assess the intestinal epithelial structure using scanning electron microscopy (SEM) and the features of patients with UC who are in remission. Methods In total, eight healthy controls and 20 patients with UC were enrolled, and colonic tissue samples from the cecum and rectum were collected. Then, we compared the epithelial surface structure on SEM between patients with UC who are in clinical remission and healthy controls. Results In healthy controls, the colonic surface comprises small lobes (termed units), with one crypt located in the middle of each unit. In patients with UC, we found irregular unit and crypt mouth size, double crypt sign (> 1 crypt per unit), and lower number of small vesicles in the intestinal epithelial cells. Compared with healthy controls, patients with UC often presented with irregular unit size, double crypt sign, and irregular crypt mouth size in the rectum. The small vesicles were observed less frequently in patients with UC than in healthy controls. Conclusions SEM revealed a unique epithelial structure in patients with UC who are in remission. Keywords Intestinal epithelium · Scanning electron microscopy · Ulcerative colitis · Inflammatory bowel disease
Introduction Mucosal healing has been considered a critical treatment goal in ulcerative colitis (UC) because it contributes to a better prognosis. Endoscopic remission is a predictive outcome in patients with UC [1, 2]. The histological characteristics of UC include crypt distortion, goblet cell depletion, and inflammatory cell infiltration [3]. Histological assessment is beneficial for vertical detection. However, it cannot evaluate the structure of the mucosal surface. Recently, advanced endoscopic imaging techniques including endocytoscopy * Tomohisa Sujino [email protected] 1
Department of Gastroenterology and Hepatology, Keio University School of Medicine, Tokyo, Japan
2
Center for Diagnostic and Therapeutic Endoscopy, Keio University School of Medicine, Tokyo, Japan
3
Department of Pathology, Keio University School of Medicine, Tokyo, Japan
were developed, and they can facilitate precise and ultrastructural characterization of the mucosal surface structure in the gut. Endocytoscopy allows in vivo microscopic imaging with magnification ranging from 340- up to 1390-fold. Compared with light microscopy and endocytoscopy,
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