RESUMEN
Background and study aims: Endoscopy plays an essential role in managing patients with ulcerative colitis (UC), as it allows us to visualize and assess the severity of the disease. As such assessments are not always objective, different scores have been devised to standardize the findings. The main aim of this study was to assess the interobserver variability between the Mayo Endoscopy Score (MES), Ulcerative Colitis Endoscopy Index of Severity (UCEIS) and Ulcerative Colitis Colonoscopy Index of Severity (UCCIS) analyzing the severity of the endoscopic lesions in patients with ulcerative colitis. Patients and methods: This was a single-cohort observational study in which a colonoscopy was carried out on patients with UC, as normal clinical practice, and a video was recorded. The results from the video were classified according to the MES, UCEIS and UCCIS by three endoscopic specialists independently, and they were compared to each other. The Mayo Endoscopy Score (MES) was used to assess the clinical situation of the patient. The therapeutic impact was analyzed after colonoscopy was carried out. Results: Sixty-seven patients were included in the study. The average age was 51 (SDâ±â16.7) and the average MES was 3.07 (SDâ±â2.54). The weighted Kappa index between endoscopists A and B for the MES was 0.8; between A and C 0.52; and between B and C 0.49.âThe intraclass correlation coefficient for UCEIS was 0.92 among the three endoscopists (CI 95â%: 0.83-0.96) and 0.96 for UCCIS among the three endoscopists (CI 95â% 0.94-0.97). A change in treatment for 34.3â% of the patients was implemented on seeing the results of the colonoscopy. Conclusions: There was an adequate, but not perfect, correlation between the different endoscopists for MES, UCEIS, UCCIS.âThis was higher with the last two scores. Thus, there is still some subjectivity to be minimized through special training, on assessing the seriousness of the endoscopic lesions in patients with UC.
RESUMEN
INTRODUCCIÓN: la endoscopia tiene un papel fundamental en el manejo de los pacientes con colitis ulcerosa (CU), ya que permite la visualización y evaluación de la gravedad de la enfermedad. No obstante, dicha evaluación no es siempre algo objetivo, por lo que se han desarrollado diferentes escalas que pretenden homogeneizar los hallazgos. Objetico: el objetivo del estudio fue evaluar la variabilidad interobservador entre el Índice de Mayo Endoscópico (IME) y el Índice de Severidad Endoscópica de la Colitis Ulcerosa (UCEIS), al analizar la gravedad de las lesiones endoscópicas en pacientes con CU. El objetivo secundario fue analizar si la preparación catártica afectaba al grado de concordancia entre los endoscopistas. MATERIAL Y MÉTODOS: se trata de un estudio observacional comparativo de una única cohorte a la cual se realiza una colonoscopia bajo guía de práctica clínica habitual a pacientes con CU y se estadifica según el IME y el UCEIS por tres endoscopistas expertos. Para valorar el grado de correlación interobservador se utilizaron el índice de Kappa para el IME y el coeficiente de correlación intraclase para el UCEIS. Se incluyeron 67 pacientes, con edad media de 51 años (DE ± 16,7) e índice de Mayo clínico medio de 3,07 (DE ± 2,54). RESULTADOS: el índice de Kappa ponderado entre los endoscopistas A y B para el IME fue de 0,8; entre el A y el C, de 0,52; y entre el B y el C, de 0,49. Para el UCEIS, el coeficiente de correlación intraclase fue del 0,922 entre los tres endoscopistas (IC 95 %: 0,832-0,959). Se encontró una mejor correlación interobservador cuando la preparación catártica era ≥ 8 según la escala de Boston. CONCLUSIÓN: existe, por tanto, una superior correlación entre los diferentes endoscopistas para el UCEIS que para el IME, por lo que debería ser considerado como el mejor índice a utilizar en la práctica clínica. Una buena preparación catártica es importante para mejorar la correlación interobservador
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Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Colitis Ulcerosa/diagnóstico por imagen , Colitis Ulcerosa/patología , Colonoscopía/métodos , Índice de Severidad de la Enfermedad , Estándares de Referencia , Valores de Referencia , Variaciones Dependientes del ObservadorRESUMEN
INTRODUCTION: endoscopy plays an essential role in the management of patients with ulcerative colitis (UC), as it allows us to visualize and assess the severity of the disease. Different scores have been devised to standardize the findings because such assessments are not always objective. AIMS: the aim of this study was to assess the interobserver variability between the Index of Mayo Endoscopy (IME) and the Ulcerative Colitis Endoscopy Index of Severity (UCEIS), analyzing the severity of the endoscopic lesions in patients with UC. The secondary aim was to analyze if the cathartic preparation affected the degree of concordance amongst the endoscopists. MATERIAL AND METHODS: this was a single-cohort observational, comparative study in which a colonoscopy was performed in patients with UC, as the normal clinical practice. The results were classified according to the IME and the UCEIS by three endoscopic specialists. In order to assess the degree of interobserver correlation, the Kappa index for IME was used and the intraclass correlation coefficient was used for UCEIS. RESULTS: sixty-seven patients were included in the study. The average age was 51 (SD ± 16.7) and the average Mayo Clinic index was 3.07 (SD ± 2.54). The weighted Kappa index between endoscopists A and B for the IME was 0.8, 0.52 between A and C and 0.49 between B and C. The intraclass correlation coefficient for UCEIS was 0.922 between the three endoscopists (95 % CI: 0.832-0.959). A better interobserver correlation was found when the cathartic preparation was ≥ 8 based on the Boston Scale. CONCLUSIONS: there was a higher correlation between the different endoscopists for the UCEIS than for the IME. Thus, this should be considered to be the best index to use in the clinical practice. A good cleansing preparation is important to improve the interobserver correlation.