Interobserver agreement of current and new proposed endoscopic scores for postoperative recurrence in Crohn's disease.
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Bak Michiel T J, Hammoudi Nassim, Allez Matthieu, Silverberg Mark S, Schellekens Isa M, Erler Nicole S, Dijkstra Gerard, Romberg-Camps Mariëlle, de Boer Nanne K H, Jansen Sita V, van der Marel Sander, Horjus Carmen S, Visschedijk Marijn C, Goetgebuer Rogier L, van Dop Willemijn A, Hoekstra Jildou, Bodelier Alexander G L, Molendijk Ilse, Derikx Lauranne A A P, van Schaik Fiona D M, West Rachel L, Duijvestein Marjolijn, Janneke van der Woude C, van Ruler Oddeke, de Vries Annemarie C, Dutch Initiative on Crohn and Colitis and the RAP-CD study group
Аннотация
METHODS: Sixteen Dutch academic and nonacademic inflammatory bowel disease specialists assessed endoscopic videos (n = 71) of postoperative CD patients (n = 66) retrieved from 9 Dutch centers. Each video was assessed for degree of inflammation by 4 gastroenterologists using the mRS and the new proposed endoscopic score: the REMIND score (separate score of anastomosis and neoterminal ileum) and the updated Rutgeerts score (assessment of lesions at the anastomotic line, ileal inlet, ileal body, and neoterminal ileum). In addition, lesions at the ileal body, ileal inlet, neoterminal ileum, and colonic and/or ileal blind loop were separately assessed. Interobserver agreement was assessed by using Fleiss' weighted kappa.
RESULTS: Fleiss' weighted kappa for the mRS was .67 (95% confidence interval [CI], .59-.74). The weighted kappa for the REMIND score was .73 (95% CI, .65-.80) for lesions in the neoterminal ileum and .46 (95% CI, .35-.58) for anastomotic lesions. The weighted kappa for the updated Rutgeerts score was .69 (95% CI, .62-.77). The weighted kappa for lesions in the ileal body, ileal inlet, neoterminal ileum, and colonic and ileal blind loop was .61 (95% CI, .49-.73), .63 (95% CI, .54-.72), .61 (95% CI, .49-.74), .83 (95% CI, .62-1.00) and .68 (95% CI, .46-.89), respectively.
CONCLUSIONS: The interobserver agreement of the mRS is substantial. Similarly, the interobserver agreement is substantial for the updated Rutgeerts score. According to the REMIND score, the interobserver agreement was substantial for lesions in the neoterminal ileum, although only moderate for anastomotic lesions. Because therapeutic decisions in clinical practice are based on these assessments, and these scores are used as outcome measure in clinical studies, further improvement of the interobserver agreement is essential.