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The Paddington International Virtual Chromoendoscopy Score in ulcerative colitis exhibits very good inter-rater agreement after computerized module training: a multicenter study across academic and community practice (with video)

Published:March 13, 2018DOI:https://doi.org/10.1016/j.gie.2018.02.044

      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.

      Abbreviations:

      AUROC (area under the receiver operating characteristic curve), EVC (electronic virtual chromoendoscopy), HD (high definition), ICC (intraclass correlation coefficient), NBI (narrow-band imaging), PICaSSO (Paddington International Virtual Chromoendoscopy Score), UC (ulcerative colitis), UCEIS (Ulcerative Colitis Endoscopic Index of Severity)
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      References

        • Rutgeerts P.
        • Sandborn W.J.
        • Feagan B.G.
        • et al.
        Infliximab for induction and maintenance therapy for ulcerative colitis.
        N Engl J Med. 2005; 353: 2462-2476
        • Feagan B.G.
        • Rutgeerts P.
        • Sands B.E.
        • et al.
        Vedolizumab as induction and maintenance therapy for ulcerative colitis.
        N Engl J Med. 2013; 369: 699-710
        • Sandborn W.J.
        • Feagan B.G.
        • Stoinov S.
        • et al.
        Certolizumab pegol for the treatment of Crohn’s disease.
        N Engl J Med. 2007; 357: 228-238
        • Sandborn W.J.
        • Feagan B.G.
        • Wolf D.C.
        • et al.
        Ozanimod induction and maintenance treatment for ulcerative colitis.
        N Engl J Med. 2016; 374: 1754-1762
        • Vermeire S.
        • O’Byrne S.
        • Keir M.
        • et al.
        Etrolizumab as induction therapy for ulcerative colitis: a randomised, controlled, phase 2 trial.
        Lancet. 2014; 384: 309-318
        • Sandborn W.J.
        • Su C.
        • Sands B.E.
        • et al.
        Tofacitinib as induction and maintenance therapy for ulcerative colitis.
        N Engl J Med. 2017; 376: 1723-1736
        • Walsh A.J.
        • Bryant R.V.
        • Travis S.P.L.
        Current best practice for disease activity assessment in IBD.
        Nat Rev Gastroenterol Hepatol. 2016; 13: 567-579
        • Samaan M.A.
        • Mosli M.H.
        • Sandborn W.J.
        • et al.
        A systematic review of the measurement of endoscopic healing in ulcerative colitis clinical trials: recommendations and implications for future research.
        Inflamm Bowel Dis. 2014; 20: 1465-1471
        • Vuitton L.
        • Peyrin-Biroulet L.
        • Colombel J.F.
        • et al.
        Defining endoscopic response and remission in ulcerative colitis clinical trials: an international consensus.
        Aliment Pharmacol Ther. 2017; 45: 801-813
        • Iacucci M.
        • Panaccione R.
        Recent advances in the endoscopic assessment of ulcerative colitis.
        Tech Gastrointest Endosc. 2016; 18: 116-122
        • Schroeder K.W.
        • Tremaine W.J.
        • Ilstrup D.M.
        Coated oral 5-aminosalicylic acid therapy for mildly to moderately active ulcerative colitis. A randomized study.
        N Engl J Med. 1987; 317: 1625-1629
        • Cooney R.M.
        • Warren B.F.
        • Altman D.G.
        • et al.
        Outcome measurement in clinical trials for ulcerative colitis: towards standardisation.
        Trials. 2007; 8: 17
        • Barreiro-de Acosta M.
        • Vallejo N.
        • de la Iglesia D.
        • et al.
        Evaluation of the risk of relapse in ulcerative colitis according to the degree of mucosal healing (Mayo 0 vs 1): a longitudinal cohort study.
        J Crohns Colitis. 2016; 10: 13-19
        • Manginot C.
        • Baumann C.
        • Peyrin-Biroulet L.
        An endoscopic Mayo score of 0 is associated with a lower risk of colectomy than a score of 1 in ulcerative colitis.
        Gut. 2015; 64: 1181-1182
        • Travis S.P.L.
        • Schnell D.
        • Krzeski P.
        • et al.
        Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS).
        Gut. 2012; 61: 535-542
        • Travis S.P.L.
        • Schnell D.
        • Krzeski P.
        • et al.
        Reliability and initial validation of the Ulcerative Colitis Endoscopic Index of Severity.
        Gastroenterology. 2013; 145: 987-995
        • Arai M.
        • Naganuma M.
        • Sugimoto S.
        • et 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: 1303-1309
        • Saigusa K.
        • Matsuoka K.
        • Sugimoto S.
        • et al.
        Ulcerative colitis endoscopic index of severity is associated with long-term prognosis in ulcerative colitis patients treated with infliximab.
        Dig Endosc. 2016; 28: 665-670
        • Ikeya K.
        • Hanai H.
        • Sugimoto K.
        • et 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: 286-295
        • Bryant R.V.
        • Burger D.C.
        • Delo J.
        • et al.
        Beyond endoscopic mucosal healing in UC: histological remission better predicts corticosteroid use and hospitalisation over 6 years of follow-up.
        Gut. 2016; 65: 408-414
        • Iacucci M.
        • Fort Gasia M.
        • Hassan C.
        • et al.
        Complete mucosal healing defined by endoscopic Mayo subscore still demonstrates abnormalities by novel high definition colonoscopy and refined histological gradings.
        Endoscopy. 2015; 47: 726-734
        • Iacucci M.
        • Daperno M.
        • Lazarev M.
        • et al.
        Development and reliability of the new endoscopic virtual chromoendoscopy score: the PICaSSO (Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis.
        Gastrointest Endosc. 2017; 86: 1118-1127
        • Hefti M.M.
        • Chessin D.B.
        • Harpaz N.
        • et al.
        Severity of inflammation as a predictor of colectomy in patients with chronic ulcerative colitis.
        Dis Colon Rectum. 2009; 52: 193-197
        • Oremus M.
        • Oremus C.
        • Hall G.B.C.
        • et al.
        Inter-rater and test-retest reliability of quality assessments by novice student raters using the Jadad and Newcastle-Ottawa Scales.
        BMJ Open. 2012; 2: e001368
        • Gasia M.F.
        • Ghosh S.
        • Panaccione R.
        • et al.
        Targeted biopsies identify larger proportions of patients with colonic neoplasia undergoing high-definition colonoscopy, dye chromoendoscopy, or electronic virtual chromoendoscopy.
        Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2016; 14: 704-712
        • Gupta N.
        • Brill J.V.
        • Canto M.
        • et al.
        AGA White paper: training and implementation of endoscopic image enhancement technologies.
        Clin Gastroenterol Hepatol. 2017; 15: 820-826
        • Rastogi A.
        • Rao D.S.
        • Gupta N.
        • et al.
        Impact of a computer-based teaching module on characterization of diminutive colon polyps by using narrow-band imaging by non-experts in academic and community practice: a video-based study.
        Gastrointest Endosc. 2014; 79: 390-398
        • Ignjatovic A.
        • Thomas-Gibson S.
        • East J.E.
        • et al.
        Development and validation of a training module on the use of narrow-band imaging in differentiation of small adenomas from hyperplastic colorectal polyps.
        Gastrointest Endosc. 2011; 73: 128-133
        • Raghavendra M.
        • Hewett D.G.
        • Rex D.K.
        Differentiating adenomas from hyperplastic colorectal polyps: narrow-band imaging can be learned in 20 minutes.
        Gastrointest Endosc. 2010; 72: 572-576
        • Patel S.G.
        • Schoenfeld P.
        • Kim H.M.
        • et al.
        Real-time characterization of diminutive colorectal polyp histology using narrow-band imaging: implications for the resect and discard strategy.
        Gastroenterology. 2016; 150: 406-418
        • Hayashi S.
        • Kudo S.
        • Ogata N.
        • et al.
        Narrow-band imaging efficiency for evaluation of mucosal healing/relapse of ulcerative colitis [abstract].
        Gastrointest Endosc. 2016; 83: AB154
        • Osada T.
        • Ohkusa T.
        • Yokoyama T.
        • et al.
        Comparison of several activity indices for the evaluation of endoscopic activity in UC: inter- and intraobserver consistency.
        Inflamm Bowel Dis. 2010; 16: 192-197
        • Feagan B.G.
        • Sandborn W.J.
        • D’Haens G.
        • et al.
        The role of centralized reading of endoscopy in a randomized controlled trial of mesalamine for ulcerative colitis.
        Gastroenterology. 2013; 145: 149-157
        • Mandrekar J.N.
        Measures of interrater agreement.
        J Thorac Oncol. 2011; 6: 6-7