Philippe Marteau1, David Laharie2, Jean-Frédéric Colombel3, Laurence Martin4, Hugues Coevoet5, Matthieu Allez6, Guillaume Cadiot7, Arnaud Bourreille8, Franck Carbonnel9, Yoram Bouhnik10, Benoit Coffin11, Bernard Duclos12, Jean Louis Dupas13, Jacques Moreau14, Edouard Louis15, Jean-Yves Mary16. 1. Service d'Hépatogastroentérologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris cedex, France Denis Diderot - Paris7 University, Paris, France. 2. CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie - Université Bordeaux, Laboratoire de bactériologie, F-33000 Bordeaux, Pessac, France david.laharie@chu-bordeaux.fr. 3. CHRU de Lille, Hôpital Claude Huriez, Service des Maladies de l'Appareil Digestif -Endoscopie Digestive, Lille, France Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. 4. Service d'Hépatogastroentérologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris cedex, France. 5. CHRU de Lille, Hôpital Claude Huriez, Service des Maladies de l'Appareil Digestif -Endoscopie Digestive, Lille, France. 6. Department of Hepatogastroenterology, Hôpital Saint-Louis, Paris, France. 7. Department of Hepato-Gastroenterology and Digestive Oncology, Hôpital Robert Debré, Boulevard du Général Koenig, 51100 Reims Cedex, France. 8. CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, F-44093 Nantes, France. 9. Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospitals Paris-Sud, Site de Bicêtre, Paris Sud University, Paris XI, Le Kremlin Bicêtre, Villejuif, France. 10. Hôpital Beaujon, Gastroentérologie, Maladies Inflammatoires Chroniques de l'Intestin et Assistance Nutritive, APHP- Université Paris Diderot Paris 7, Clichy, France. 11. Hôpital Louis Mourier, service d'Hépato-Gastroentérologie, Pôle Maladie Appareil Digestif, APHP - Université Paris VII, F-92700 Colombes, France. 12. Service d'Hépato-Gastroentérologie et Assistance Nutritive, CHU Strasbourg, Strasbourg, France. 13. Service d'Hépato- Gastroentérologie, CHU Amiens, Université de Picardie Jules Verne, Amiens, France. 14. CHU de Toulouse, Hôpital Rangueil, Service de Gastro-entérologie et Nutrition, F-31059 Toulouse, France. 15. Centre Hospitalier, Universitaire de Liège, Liège, Belgium. 16. Inserm UMR 1153, Equipe Epidemiologie Clinique, Statistique pour la Recherche en Santé, Hôpital Saint-Louis, Université Paris Diderot - Paris 7, Paris, France.
Abstract
BACKGROUND: After resection surgery for Crohn's disease, recurrence of endoscopic lesions at the site of the anastomosis or in the neoterminal ileum is graded according to the Rutgeerts score (RS). The goal of this study was to test the interobserver variability for RS. METHODS:Thirteen trained endoscopists evaluated the RS on 39 videotapes of patients who had undergone resection for Crohn's disease with an ileocolonic anastomosis 6 months earlier. Videotapes were randomly assigned to endoscopists through a balanced incomplete block design. Each videotape was scored independently by four endoscopists, and each endoscopist evaluated 12 videotapes, making a total of 156 videotape assessments. Reproducibility levels of the RS were assessed through unweighted kappa estimates among multiple raters. The proportion of inappropriate therapeutic initiation was estimated by randomly selecting one endoscopist for each videorecording, assuming that the majority of endoscopists correctly classified endoscopic recurrence. RESULTS: The kappa estimates were 0.43 (95% confidence interval: 0.33-0.52) for the RS on a 5-grade scale, 0.47 (0.28-0.66) for RS < i2 vs. ≥ i2, and 0.64 (0.42-0.85) for RS ≤ i2 vs. > i2. The percentages of inappropriate therapeutic initiation were 12.8% (3.8-21.9) when initiation was triggered by a RS ≥ i2 and 8.3% (1.1-15.6) when initiation was triggered by a RS > i2 (p = 0.41). CONCLUSION: The reproducibility of the RS was moderate, especially when differentiating <i2 from ≥i2, which may lead to incorrect therapeutic decisions in >10% of patients.
RCT Entities:
BACKGROUND: After resection surgery for Crohn's disease, recurrence of endoscopic lesions at the site of the anastomosis or in the neoterminal ileum is graded according to the Rutgeerts score (RS). The goal of this study was to test the interobserver variability for RS. METHODS: Thirteen trained endoscopists evaluated the RS on 39 videotapes of patients who had undergone resection for Crohn's disease with an ileocolonic anastomosis 6 months earlier. Videotapes were randomly assigned to endoscopists through a balanced incomplete block design. Each videotape was scored independently by four endoscopists, and each endoscopist evaluated 12 videotapes, making a total of 156 videotape assessments. Reproducibility levels of the RS were assessed through unweighted kappa estimates among multiple raters. The proportion of inappropriate therapeutic initiation was estimated by randomly selecting one endoscopist for each videorecording, assuming that the majority of endoscopists correctly classified endoscopic recurrence. RESULTS: The kappa estimates were 0.43 (95% confidence interval: 0.33-0.52) for the RS on a 5-grade scale, 0.47 (0.28-0.66) for RS < i2 vs. ≥ i2, and 0.64 (0.42-0.85) for RS ≤ i2 vs. > i2. The percentages of inappropriate therapeutic initiation were 12.8% (3.8-21.9) when initiation was triggered by a RS ≥ i2 and 8.3% (1.1-15.6) when initiation was triggered by a RS > i2 (p = 0.41). CONCLUSION: The reproducibility of the RS was moderate, especially when differentiating <i2 from ≥i2, which may lead to incorrect therapeutic decisions in >10% of patients.
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