E Garofalo1, A Spinelli2,3, G Pellino4, K Flashman5, M Frasson6, M Carvello7, N de'Angelis8, A Garcia-Granero9, M Harper10, J Warusavitarne11, M Coleman12, E Espin13, F Selvaggi4. 1. La Sapienza University, Rome, Italy. eleonora.garofalo93@gmail.com. 2. Humanitas Clinical and Research Center - IRCCS, via Manzoni 56, 20089, Rozzano (Milan), Italy. 3. Humanitas University, Department of Biomedical Sciences, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy. 4. Department of Advanced Medical and Surgical Sciences, Universitá Della Campania Luigi Vanvitelli, Naples, Italy. 5. Colorectal Unit, Queen Alexandra Hospital - Portsmouth Hospitals NHS Trust, Portsmouth, UK. 6. Department of General Surgery, Colorectal Unit, La Fe University and Polytechnic Hospital, University of Valencia, Valencia, Spain. 7. Colon and Rectal Surgery Division, Humanitas University, Rozzano (Milan), Italy. 8. Department of Digestive Surgery, Assistance Publique Hôpitaux de Paris, Henri Mondor Hospital, Université Paris-Est (UEP), Créteil, France. 9. Colorectal Unit, Hospital Universitario Son Espases, Palma de Mallorca, Spain. 10. University of Portsmouth, Portsmouth, UK. 11. Department of Colorectal Surgery, St Mark's Hospital, Harrow, Middlesex, UK. 12. Department of Colorectal Surgery, University Hospitals Plymouth NHS Trust, Plymouth, UK. 13. Department of General Surgery, Hospital Valle de Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain.
Abstract
BACKGROUND: Assessment of the entire small bowel is advocated during Crohn's disease (CD) surgery, as intraoperative detection of new lesions may lead to change in the planned procedure. The aim of this study was to evaluate the inter-observer variability in the assessment of extent and severity of CD at the small bowel laparoscopic "walkthrough". METHODS: A survey on laparoscopic assessment of the small bowel in patients with CD, including items adapted from the MREnterography or ultrasound in Crohn's disease (METRIC) study and from the classification of severity of mesenteric disease was developed by an invited committee of colorectal surgeons. Anonymous laparoscopic videos demonstrating the small bowel "walkthrough" in ileocolonic resection for primary and recurrent CD were distributed to the committee members together with the anonymous survey. The primary outcome was the rate of inter-observer variability on assessment of strictures, dilatations, complications and severity of mesenteric inflammation. RESULTS: 12 assessors completed the survey on 8 small bowel walkthrough videos. The evaluation of the small bowel thickening and of the mesenteric fat wrapping were the most reliable assessments with an overall agreement of 87.1% (k = 0.31; 95% CI - 0.22, 0.84) and 82.7% (k = 0.35; 95% CI - 0.04, 0.73), respectively. The presence of strictures and pre-stenotic dilatation demonstrated agreement of 75.2% (k = 0.06: 95% CI - 0.33, 0.45) and 71.2% (k = 0.33; 95% CI 0.15, 0.51), respectively. Evaluation of fistulae had an overall agreement of 75.3%, while there was a significant variation in the evaluation of mild, moderate and severe mesenteric disease with overall agreement ranging from 33.3 to 100%. CONCLUSION: Laparoscopic assessment of the small bowel thickening and of the presence of mesenteric fat wrapping is reliable for the intraoperative evaluation of CD with high inter-rater agreement. There is significant heterogeneity in the assessment of the severity of the mesenteric disease involvement.
BACKGROUND: Assessment of the entire small bowel is advocated during Crohn's disease (CD) surgery, as intraoperative detection of new lesions may lead to change in the planned procedure. The aim of this study was to evaluate the inter-observer variability in the assessment of extent and severity of CD at the small bowel laparoscopic "walkthrough". METHODS: A survey on laparoscopic assessment of the small bowel in patients with CD, including items adapted from the MREnterography or ultrasound in Crohn's disease (METRIC) study and from the classification of severity of mesenteric disease was developed by an invited committee of colorectal surgeons. Anonymous laparoscopic videos demonstrating the small bowel "walkthrough" in ileocolonic resection for primary and recurrent CD were distributed to the committee members together with the anonymous survey. The primary outcome was the rate of inter-observer variability on assessment of strictures, dilatations, complications and severity of mesenteric inflammation. RESULTS: 12 assessors completed the survey on 8 small bowel walkthrough videos. The evaluation of the small bowel thickening and of the mesenteric fat wrapping were the most reliable assessments with an overall agreement of 87.1% (k = 0.31; 95% CI - 0.22, 0.84) and 82.7% (k = 0.35; 95% CI - 0.04, 0.73), respectively. The presence of strictures and pre-stenotic dilatation demonstrated agreement of 75.2% (k = 0.06: 95% CI - 0.33, 0.45) and 71.2% (k = 0.33; 95% CI 0.15, 0.51), respectively. Evaluation of fistulae had an overall agreement of 75.3%, while there was a significant variation in the evaluation of mild, moderate and severe mesenteric disease with overall agreement ranging from 33.3 to 100%. CONCLUSION: Laparoscopic assessment of the small bowel thickening and of the presence of mesenteric fat wrapping is reliable for the intraoperative evaluation of CD with high inter-rater agreement. There is significant heterogeneity in the assessment of the severity of the mesenteric disease involvement.
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Authors: B Sensi; L Siragusa; C Efrati; L Petagna; M Franceschilli; V Bellato; A Antonelli; C Arcudi; M Campanelli; S Ingallinella; A M Guida; A Divizia Journal: J Immunol Res Date: 2020-12-26 Impact factor: 4.818
Authors: E Garofalo; F Selvaggi; A Spinelli; G Pellino; K Flashman; M Frasson; M Carvello; N de'Angelis; A Garcia-Granero; M Harper; J Warusavitarne; M Coleman; E Espin; V Celentano Journal: Int J Colorectal Dis Date: 2021-02-25 Impact factor: 2.796