Background & Aims

Pouchitis is a common adverse event after proctocolectomy with ileal pouch anal anastomosis for ulcerative colitis. Evaluation of pouchitis disease activity and response to treatment requires use of validated indices. We assessed the reliability of items evaluating endoscopic pouchitis disease activity.

Methods

Twelve panelists used a modified RAND appropriateness methodology to rate the appropriateness of items evaluating endoscopic pouchitis disease activity derived from a systematic review, and also identified additional potential endoscopic items based on expert opinion. Four central readers then evaluated 50 pouchoscopy videos in triplicate, in random order. Intra- and inter-rater reliability for each item was assessed by calculating and comparing intra-class correlation coefficients (ICCs). A Delphi process identified common sources of disagreement among the readers.

Results

Ten existing endoscopic items were identified from the systematic review and an additional 7 exploratory items from the panelists. Intra-class correlation coefficients (95% confidence interval [CI]) for inter-rater reliability were highest for the existing item of pouch ulceration (0.72; 95% CI, 0.60-0.82) and for the exploratory item of ulcerated surface in the pouch body (0.67; 95% CI, 0.53-0.75). Inter-rater reliability for all other existing and exploratory items was “moderate” (ICC<0.60). The item ulcerated surface in the pouch body demonstrated the best correlation with a global evaluation of lesion severity (r=0.80; 95% CI, 0.73-0.85).

Conclusion

Substantial reliability was observed only for the endoscopic items of ulceration and ulcerated surface in the pouch body. Future studies should assess responsiveness to treatment in the next stage toward development of an endoscopic pouchitis disease activity index.

中文翻译：

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中心读者在评估囊炎内窥镜疾病活动中的可靠性

背景与目标

在溃疡性结肠炎的结肠切除术中，回肠囊肛门吻合术是常见的不良事件。评估囊炎疾病活动性和对治疗的反应需要使用经过验证的指标。我们评估了评估内窥镜囊炎疾病活动的项目的可靠性。

方法

十二名专门小组成员使用经过改进的RAND适当性方法，对通过系统评价得出的评估内窥镜囊炎疾病活动的项目的适当性进行评分，并根据专家意见确定了其他潜在的内窥镜项目。然后，四个中央阅读器以随机顺序一式三份地评估了50个阴道镜录像。通过计算和比较类内相关系数（ICC）来评估每个项目的评价者内部和评价者之间的可靠性。德尔菲过程确定了读者之间意见分歧的常见根源。

结果

从系统评价中确定了十个现有的内窥镜检查项目，并从小组成员中确定了另外七个探索性检查项目。评估者间可靠性的类内相关系数（95％置信区间[CI]）对于现有小袋溃疡项目（0.72; 95％CI，0.60-0.82）和小袋溃疡表面探索项目的类别相关系数最高身体（0.67; 95％CI，0.53-0.75）。所有其他现有和探索性项目的评估者间可靠性为“中等”（ICC <0.60）。袋体中溃疡表面的表面与病变严重程度的整体评估表现出最好的相关性（r = 0.80； 95％CI，0.73-0.85）。

结论

仅对于囊体内的溃疡和溃疡表面的内窥镜检查项目，观察到了充分的可靠性。未来的研究应评估对内窥镜囊炎疾病活动指数发展的下一阶段对治疗的反应性。