Palak J Trivedi1, Ralf Kiesslich2, James Hodson3, Neeraj Bhala4, Ralph A Boulton4, Rachel Cooney4, Xianyong Gui5, Tariq Iqbal4, Ka-Kit Li6, Saqib Mumtaz7, Shri Pathmakanthan4, Mohammed Nabil Quraishi4, Vandana M Sagar8, Ashit Shah7, Naveen Sharma9, Keith Siau7, Samuel Smith4, Stephen Ward10, Monika M Widlak11, Raf Bisschops12, Subrata Ghosh13, Marietta Iacucci13. 1. National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom. 2. Department of Medicine, Division of Gastroenterology, HSK Hospital, Wiesbaden, Germany. 3. Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom. 4. Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom. 5. Department of Pathology and Laboratory Medicine, University of Calgary and Calgary Laboratory Services, Calgary, Alberta, Canada. 6. Department of Gastroenterology and Hepatology, Leicester Royal Infirmary, Leicester, United Kingdom. 7. Department of Gastroenterology, Royal Wolverhampton Hospitals NHS Trust, Wolverhampton, United Kingdom. 8. National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Liver Unit, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom. 9. Department of Gastroenterology, University Hospitals Birmingham Heart of England Foundation Trust, Birmingham, United Kingdom. 10. Department of Colorectal Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom. 11. Department of Gastroenterology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Warwick, United Kingdom. 12. Department of Gastroenterology and Hepatology, University Hospitals Leuven, KU Leuven, Leuven, Belgium. 13. National Institute of Health Research (NIHR) Birmingham, Biomedical Research Centre (BRC), University of Birmingham, Birmingham, United Kingdom; Department of Gastroenterology, University Hospitals Birmingham Queen Elizabeth, Birmingham, United Kingdom; Institute of Translational Medicine, Institute of Immunology and Immunotherapy Birmingham, United kingdom; Division of Gastroenterology, University of Calgary, Calgary, Alberta, Canada.
Abstract
BACKGROUND AND AIMS: Electronic virtual chromoendoscopy (EVC) can demonstrate ongoing disease activity in ulcerative colitis (UC), even when Mayo subscores suggest healing. However, applicability of EVC technology outside the expert setting has yet to be determined. METHODS: Fifteen participants across 5 centers reviewed a computerized training module outlining high-definition and EVC (iScan) colonoscopy modes. Interobserver agreement was then tested (Mayo score, Ulcerative Colitis Endoscopic Index of Severity [UCEIS], and the Paddington International Virtual Chromoendoscopy Score [PICaSSO] for UC), using a colonoscopy video library (30 cases reviewed pretraining and 30 post-training). Knowledge sustainability was retested in a second round (42 cases; 9/15 participants), 6 months after training provision. RESULTS: Pretraining intraclass correlation coefficients (ICC) were good for the Mayo endoscopic subscore (ICC, .775), UCEIS scoring erosions/ulcers (ICC, .770), and UCEIS overall (ICC, .786) and for mucosal (ICC, .754) and vascular components of PICaSSO (ICC, .622). For the vascular components of UCEIS, agreement was only moderate (ICC, .429) and did not enhance post-training (ICC, .417); conversely, use of PICaSSO improved post-training (mucosal ICC, .848; vascular, .746). Histologic correlation using the New York Mt. Sinai System was strong for both PICaSSO components (Spearman's ρ for mucosal: .925; vascular, .873; P < .001 for both). Moreover, accuracy in specifically discriminating quiescent from mild histologic strata was strongest for PICaSSO (area under the receiver operating characteristic curve [AUROC] for mucosal, .781; vascular, .715) compared with Mayo (AUROC, .708) and UCEIS (AUROC for UCEIS overall, .705; vascular, .562; bleeding, .645; erosions/ulcers, .696). Inter-rater reliability for PICaSSO was sustained by round 2 participants (round 1 and 2 ICC for mucosal, .873 and .869, respectively; vascular, .715 and .783, respectively), together with histologic correlation (ρ mucosal, .934; vascular, .938; P < .001 for both). CONCLUSIONS: PICaSSO demonstrates good interobserver agreement across all levels of experience, providing excellent correlation with histology. Given the ability to discriminate subtle endoscopic features, PICaSSO may be applied to refine stratified treatment paradigms for UC patients.
BACKGROUND AND AIMS: Electronic virtual chromoendoscopy (EVC) can demonstrate ongoing disease activity in ulcerative colitis (UC), even when Mayo subscores suggest healing. However, applicability of EVC technology outside the expert setting has yet to be determined. METHODS: Fifteen participants across 5 centers reviewed a computerized training module outlining high-definition and EVC (iScan) colonoscopy modes. Interobserver agreement was then tested (Mayo score, Ulcerative Colitis Endoscopic Index of Severity [UCEIS], and the Paddington International Virtual Chromoendoscopy Score [PICaSSO] for UC), using a colonoscopy video library (30 cases reviewed pretraining and 30 post-training). Knowledge sustainability was retested in a second round (42 cases; 9/15 participants), 6 months after training provision. RESULTS: Pretraining intraclass correlation coefficients (ICC) were good for the Mayo endoscopic subscore (ICC, .775), UCEIS scoring erosions/ulcers (ICC, .770), and UCEIS overall (ICC, .786) and for mucosal (ICC, .754) and vascular components of PICaSSO (ICC, .622). For the vascular components of UCEIS, agreement was only moderate (ICC, .429) and did not enhance post-training (ICC, .417); conversely, use of PICaSSO improved post-training (mucosal ICC, .848; vascular, .746). Histologic correlation using the New York Mt. Sinai System was strong for both PICaSSO components (Spearman's ρ for mucosal: .925; vascular, .873; P < .001 for both). Moreover, accuracy in specifically discriminating quiescent from mild histologic strata was strongest for PICaSSO (area under the receiver operating characteristic curve [AUROC] for mucosal, .781; vascular, .715) compared with Mayo (AUROC, .708) and UCEIS (AUROC for UCEIS overall, .705; vascular, .562; bleeding, .645; erosions/ulcers, .696). Inter-rater reliability for PICaSSO was sustained by round 2 participants (round 1 and 2 ICC for mucosal, .873 and .869, respectively; vascular, .715 and .783, respectively), together with histologic correlation (ρ mucosal, .934; vascular, .938; P < .001 for both). CONCLUSIONS: PICaSSO demonstrates good interobserver agreement across all levels of experience, providing excellent correlation with histology. Given the ability to discriminate subtle endoscopic features, PICaSSO may be applied to refine stratified treatment paradigms for UC patients.
Authors: Olga Maria Nardone; Alina Bazarova; Pradeep Bhandari; Rosanna Cannatelli; Marco Daperno; Jose Ferraz; Martin Goetz; Xianyong Gui; Bu Hayee; Gert De Hertogh; Mark Lazarev; Ji Li; Adolfo Parra-Blanco; Luca Pastorelli; Remo Panaccione; Vincenzo Occhipinti; Timo Rath; Samuel C L Smith; Uday N Shivaji; Gian Eugenio Tontini; Michael Vieth; Vincenzo Villanacci; Davide Zardo; Raf Bisschops; Ralf Kiesslich; Subrata Ghosh; Marietta Iacucci Journal: United European Gastroenterol J Date: 2022-02-23 Impact factor: 4.623