Ulcerative Colitis Endoscopic Index of Severity is Feasible and Useful for Evaluation of Endoscopic Activity in Ulcerative Colitis Patients in a Real-life Setting

Ulcerative Colitis Endoscopic Index of Severity is Feasible and Useful for Evaluation of... Dear Editor, To reduce variability of endoscopic reports in ulcerative colitis [UC] patients, many indexes have been proposed, but at present no ‘gold standard’ exists.1 The Mayo endoscopic score [MES] is the most widely used index in clinical trial and practice, but, more recently, the ulcerative colitis endoscopic index [UCEIS], which includes objective endoscopic features and has demonstrated better prognostic value, has been developed and validated.2–4 The aim of the present study was to evaluate the feasibility of using UCEIS in a real-life setting, in comparison with MES, in experienced and unexperienced endoscopists, and the effect of an image-based specific training. Two-minute video recordings, representing all the colonic segments, were obtained from colonoscopies performed at S. Andrea Hospital in Rome, Italy. The videos were first observed and scored by two expert readers from two different centres, and concordance rate [κ] and Spearman correlation [r] between the two scores were calculated. Seven trainee gastroenterologists evaluated six videos before and six videos after a 20-min period of image-based training with a focus on the two endoscopic scores. The trainees had at least 1 year of endoscopic experience, autonomy in performing and reporting endoscopic procedures, no specific expertise in inflammatory bowel disease [IBD] and were unaware of the patients’ clinical data. Weighted inter-observer agreement [IA] and agreement with the expert operator [central reader], as well as correlation between the two scores, were calculated before and after training. Agreement between expert operators was good both for MES (k = 0.756, 95% confidence interval [CI]: 0.55–0.961) and for UCEIS [k = 0.686, 95% CI: 0.498–0.873], and the two scores displayed an excellent correlation [r = 0.893, p < 0.0001; 95% CI: 0.756–0.955] [Figure 1A]. In the trainee group, UCEIS performed slightly better than MES, and the image-based training improved the performance of both scores. The IA of MES increased from k = 0.3 [95% CI: 0.18–0.41] to 0.57 [0.45–0.69] and that of UCEIS from k = 0.55 [0.42–0.68] to 0.61 [0.49–0.73]. Regarding agreement with the central reader, the k value of MES increased from 0.55 [95% CI: 0.39–0.70] to 0.57 [0.42–0.73], and that of UCEIS from 0.42 [0.30–0.55] to 0.63 [0.52–0.74]]. Correlation between the scores increased from r = 0.76 [p = 0.0001; 95% CI: 0.594–0.865] to r = 0.80 [p = 0.0001; 95% CI: 0.658–0.889] [Figure 1B]. At the end of the study, the majority of the trainees (4/7 [57%]) declared that of the two scores, they would prefer to use UCEIS in future daily practice. Figure 1. View largeDownload slide [A] Performance of UCEIS and MES in experienced endoscopists: inter-observer agreement [i] and correlation between the two scores [ii], with regression line represented. [B] Performance of UCEIS and MES in inexperienced endoscopists before and after image-based training: inter-observer agreement [i], agreement with a central reader [ii], and correlation between the two scores before [iii] and after [iv] training, with regression lines represented. Figure 1. View largeDownload slide [A] Performance of UCEIS and MES in experienced endoscopists: inter-observer agreement [i] and correlation between the two scores [ii], with regression line represented. [B] Performance of UCEIS and MES in inexperienced endoscopists before and after image-based training: inter-observer agreement [i], agreement with a central reader [ii], and correlation between the two scores before [iii] and after [iv] training, with regression lines represented. In conclusion, the present study has preliminarily confirmed the feasibility and utility of UCEIS even in a real-life scenario. In fact, UCEIS was efficacious in evaluation of endoscopic activity and was particularly appreciated in the group of trainee gastroenterologists, who may well represent the community endoscopist. As already demonstrated by the results of a large Italian educational programme,5 specific training may consistently improve endoscopic score performance and diffusion. Funding No specific funding was received or utilized for the present work. Conflict of Interest The authors declare that they have no conflicts of interest in the present work. Author Contributions CP designed the study, analysed the data and wrote the paper, BMM and RL collected and analysed the data. References 1. Pagnini C, Menasci F, Desideri F, Corleto VD, Delle Fave G, Di Giulio E. Endoscopic scores for inflammatory bowel disease in the era of ‘mucosal healing’: Old problem, new perspectives. Dig Liver Dis  2016; 48: 703– 8. Google Scholar CrossRef Search ADS PubMed  2. Travis SP, Schnell D, Krzeski Pet al.   Reliability and initial validation of the ulcerative colitis endoscopic index of severity. Gastroenterology  2013; 145: 987– 95. Google Scholar CrossRef Search ADS PubMed  3. Ikeya K, Hanai H, Sugimoto Ket al.   The ulcerative colitis endoscopic index of severity more accurately reflects clinical outcomes and long-term prognosis than the Mayo endoscopic score. J Crohns Colitis  2016; 10: 286– 95. Google Scholar CrossRef Search ADS PubMed  4. Arai M, Naganuma M, Sugimoto Set al.   The ulcerative colitis endoscopic index of severity is useful to predict medium- to long-term prognosis in ulcerative colitis patients with clinical remission. J Crohns Colitis  2016; 10: 1303– 9. Google Scholar CrossRef Search ADS PubMed  5. Daperno M, Comberlato M, Bossa Fet al.  ; IGIBDEndo Group. Training programs on endoscopic scoring systems for inflammatory bowel disease lead to a significant increase in interobserver agreement among community gastroenterologists. J Crohns Colitis  2017; 11: 556– 61. Google Scholar PubMed  Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Crohn's and Colitis Oxford University Press

Ulcerative Colitis Endoscopic Index of Severity is Feasible and Useful for Evaluation of Endoscopic Activity in Ulcerative Colitis Patients in a Real-life Setting

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Publisher
Elsevier Science
Copyright
Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com
ISSN
1873-9946
eISSN
1876-4479
D.O.I.
10.1093/ecco-jcc/jjx155
Publisher site
See Article on Publisher Site

Abstract

Dear Editor, To reduce variability of endoscopic reports in ulcerative colitis [UC] patients, many indexes have been proposed, but at present no ‘gold standard’ exists.1 The Mayo endoscopic score [MES] is the most widely used index in clinical trial and practice, but, more recently, the ulcerative colitis endoscopic index [UCEIS], which includes objective endoscopic features and has demonstrated better prognostic value, has been developed and validated.2–4 The aim of the present study was to evaluate the feasibility of using UCEIS in a real-life setting, in comparison with MES, in experienced and unexperienced endoscopists, and the effect of an image-based specific training. Two-minute video recordings, representing all the colonic segments, were obtained from colonoscopies performed at S. Andrea Hospital in Rome, Italy. The videos were first observed and scored by two expert readers from two different centres, and concordance rate [κ] and Spearman correlation [r] between the two scores were calculated. Seven trainee gastroenterologists evaluated six videos before and six videos after a 20-min period of image-based training with a focus on the two endoscopic scores. The trainees had at least 1 year of endoscopic experience, autonomy in performing and reporting endoscopic procedures, no specific expertise in inflammatory bowel disease [IBD] and were unaware of the patients’ clinical data. Weighted inter-observer agreement [IA] and agreement with the expert operator [central reader], as well as correlation between the two scores, were calculated before and after training. Agreement between expert operators was good both for MES (k = 0.756, 95% confidence interval [CI]: 0.55–0.961) and for UCEIS [k = 0.686, 95% CI: 0.498–0.873], and the two scores displayed an excellent correlation [r = 0.893, p < 0.0001; 95% CI: 0.756–0.955] [Figure 1A]. In the trainee group, UCEIS performed slightly better than MES, and the image-based training improved the performance of both scores. The IA of MES increased from k = 0.3 [95% CI: 0.18–0.41] to 0.57 [0.45–0.69] and that of UCEIS from k = 0.55 [0.42–0.68] to 0.61 [0.49–0.73]. Regarding agreement with the central reader, the k value of MES increased from 0.55 [95% CI: 0.39–0.70] to 0.57 [0.42–0.73], and that of UCEIS from 0.42 [0.30–0.55] to 0.63 [0.52–0.74]]. Correlation between the scores increased from r = 0.76 [p = 0.0001; 95% CI: 0.594–0.865] to r = 0.80 [p = 0.0001; 95% CI: 0.658–0.889] [Figure 1B]. At the end of the study, the majority of the trainees (4/7 [57%]) declared that of the two scores, they would prefer to use UCEIS in future daily practice. Figure 1. View largeDownload slide [A] Performance of UCEIS and MES in experienced endoscopists: inter-observer agreement [i] and correlation between the two scores [ii], with regression line represented. [B] Performance of UCEIS and MES in inexperienced endoscopists before and after image-based training: inter-observer agreement [i], agreement with a central reader [ii], and correlation between the two scores before [iii] and after [iv] training, with regression lines represented. Figure 1. View largeDownload slide [A] Performance of UCEIS and MES in experienced endoscopists: inter-observer agreement [i] and correlation between the two scores [ii], with regression line represented. [B] Performance of UCEIS and MES in inexperienced endoscopists before and after image-based training: inter-observer agreement [i], agreement with a central reader [ii], and correlation between the two scores before [iii] and after [iv] training, with regression lines represented. In conclusion, the present study has preliminarily confirmed the feasibility and utility of UCEIS even in a real-life scenario. In fact, UCEIS was efficacious in evaluation of endoscopic activity and was particularly appreciated in the group of trainee gastroenterologists, who may well represent the community endoscopist. As already demonstrated by the results of a large Italian educational programme,5 specific training may consistently improve endoscopic score performance and diffusion. Funding No specific funding was received or utilized for the present work. Conflict of Interest The authors declare that they have no conflicts of interest in the present work. Author Contributions CP designed the study, analysed the data and wrote the paper, BMM and RL collected and analysed the data. References 1. Pagnini C, Menasci F, Desideri F, Corleto VD, Delle Fave G, Di Giulio E. Endoscopic scores for inflammatory bowel disease in the era of ‘mucosal healing’: Old problem, new perspectives. Dig Liver Dis  2016; 48: 703– 8. Google Scholar CrossRef Search ADS PubMed  2. Travis SP, Schnell D, Krzeski Pet al.   Reliability and initial validation of the ulcerative colitis endoscopic index of severity. Gastroenterology  2013; 145: 987– 95. Google Scholar CrossRef Search ADS PubMed  3. Ikeya K, Hanai H, Sugimoto Ket al.   The ulcerative colitis endoscopic index of severity more accurately reflects clinical outcomes and long-term prognosis than the Mayo endoscopic score. J Crohns Colitis  2016; 10: 286– 95. Google Scholar CrossRef Search ADS PubMed  4. Arai M, Naganuma M, Sugimoto Set al.   The ulcerative colitis endoscopic index of severity is useful to predict medium- to long-term prognosis in ulcerative colitis patients with clinical remission. J Crohns Colitis  2016; 10: 1303– 9. Google Scholar CrossRef Search ADS PubMed  5. Daperno M, Comberlato M, Bossa Fet al.  ; IGIBDEndo Group. Training programs on endoscopic scoring systems for inflammatory bowel disease lead to a significant increase in interobserver agreement among community gastroenterologists. J Crohns Colitis  2017; 11: 556– 61. Google Scholar PubMed  Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Journal

Journal of Crohn's and ColitisOxford University Press

Published: Mar 1, 2018

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