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Is sigmoidoscopy a viable alternative to colonoscopy for assessing endoscopic and histologic activity in ulcerative colitis?
Published online: August 5, 2024


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Adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study
Intest Res. 2024;22(3):310-318

Ulcerative colitis (UC) is a chronic inflammatory disorder that can cause inflammation throughout the entire colon, including the rectum. Recently, as endoscopic remission and histologic remission have been suggested as treatment goals for UC, the role of colonoscopy has become increasingly emphasized. However, frequent colonoscopies can be risky for UC patients and can lead to economic and time losses. Therefore, studies have been conducted to determine whether sigmoidoscopy can replace colonoscopy. These studies, however, have often been retrospective or lacked histologic evaluation, presenting certain limitations.
The present study was conducted as a prospective observational study. It evaluated not only endoscopic but also histologic agreement between sigmoidoscopy and colonoscopy using the Mayo Endoscopic Score (MES) and the Ulcerative Colitis Endoscopic Index of Severity (UCEIS), as well as the Nancy Index (NI), Robarts Histopathology Index (RHI), and Simplified Geboes Score (SGS). The study found a very strong agreement (κ = 0.9 or higher) for both endoscopic and histologic assessments, demonstrating that sigmoidoscopy can be a good alternative to colonoscopy for evaluating disease activity in patients with UC.

  1. This study is a single-center prospective observational study that included 100 patients with UC, excluding those with proctitis, who underwent colonoscopy over a period of one year. In addition to endoscopic evaluation, histologic assessment results were compared using the NI, RHI, and SGS.
  2. Sigmoidoscopy and colonoscopy showed strong agreement in endoscopic activity assessment. For the MES, the kappa coefficient was 0.96 with a 3% misclassification rate. Using MES ≥ 1, sigmoidoscopy achieved perfect agreement (κ = 1.00). For UCEIS, the kappa coefficient was 0.94 with a 5% misclassification rate, indicating a strong correlation.
  3. In evaluating histologic activity, sigmoidoscopy and colonoscopy showed strong concordance, with kappa coefficients of 0.86 for NI, 1.00 for RHI, and 0.92 for SGS. Misclassification rates were very low: 2% for NI, 0% for RHI, and 1% for SGS, demonstrating the high accuracy of sigmoidoscopy in detecting proximal disease activity.
  4. While sigmoidoscopy is confirmed to be a good alternative to colonoscopy for evaluating disease activity in UC, certain cases still require colonoscopy. These cases include those with primary sclerosing cholangitis, distal improvement due to topical therapy, clinically suspected active disease despite a normal sigmoidoscopy, and the need for malignancy surveillance.
Read more about adequacy of sigmoidoscopy as compared to colonoscopy for assessment of disease activity in patients of ulcerative colitis: a prospective study.

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