Background

Ulcer size is important when assessing mucosal healing in Crohn’s disease (CD) and commonly assessed with visual estimation. There is a new built-in measurement tool in the RAPID9 reader software used in colon capsule endoscopy (CCE). We aimed to assess the agreement between visually estimating ulcer size vs. using the estimation tool and the interobserver agreement for both methods independently using PillCam Colon studies in patients with Crohn’s disease.

Methods

7 experts of PillCam readers were recruited to assess CCE in this study. 7 CCE recordings were thumbnailed for the presence of ulcers. A total of 43 ulcers were consecutively selected for this study. The readers were provided with an instruction manual which specified that they were to first visually estimate the ulcer and then subsequently measure the ulcer with the size estimation tool in RAPID9 software. Two measurements were taken, A – longest distance of the ulcer end to end, and B – longest distance that is perpendicular to A. Results were analysed using Kendall’s Coefficient of Concordance (Kendall’s W).

Results

When comparing visual assessment of ulcer size vs. using the estimation tool, both measurements A and B demonstrated statistically significant agreement (p of A = 0.000, p of B = 0.000; W of A=0.90, W of B=0.82). For measurement A, our results demonstrated higher interobserver agreement when assessing ulcer size using the estimation tool (W=0.84) as compared with visually assessing ulcer size (W=0.80). This contrasts with measurement B where there was higher interobserver agreement when visually assessing ulcer size (W=0.75) as compared with using the measurement tool (W=0.73). Nevertheless, there was no statistically significant variability amongst measurement A nor B (p = 0.000) in visual assessment and measurement tool.

Conclusion

The conventional visual estimation of ulcer size in CD using CCE was just as accurate as the measurement tool. Furthermore, consistency between readers was demonstrated with the high level of interobserver agreement for the measurement tool and visual estimation. This novel finding is reassuring given the decade of capsule studies done with older software, where a measurement tool was not available. Further study should be conducted to assess and consolidate the validity of the estimation tool in assessing ulceration and mucosal healing in CD with a larger number and variety of lesions studied.

中文翻译：

---

P156使用PillCam COLON2中的RAPID9软件，在克罗恩病中观察者的视觉评估与溃疡大小之间的差异

背景

当评估克罗恩病（CD）的黏膜愈合时，溃疡大小很重要，通常通过视觉评估来评估。在结肠囊膜内窥镜检查（CCE）中使用的RAPID9阅读器软件中有一个新的内置测量工具。我们旨在评估使用克罗恩病患者在视觉上估计溃疡大小与使用估计工具之间的一致性，以及使用PillCam Colon研究独立地针对两种方法的观察者间一致性。

方法

本研究招募了7位PillCam读者专家来评估CCE。缩略了7个CCE记录中溃疡的存在。总共选择了43个溃疡进行此项研究。为读者提供了一份说明手册，说明他们首先要目视评估溃疡，然后再使用RAPID9软件中的尺寸评估工具测量溃疡。进行了两次测量，A –溃疡端到端的最长距离，B –垂直于A的最长距离。使用肯德尔一致性系数（肯德尔W）分析结果。

结果

当比较溃疡大小的视觉评估与使用评估工具进行视觉评估时，测量值A和B均显示出统计学上的显着一致性（A = 0.000，B = 0.000； A = 0.90，B = 0.82，W）。对于测量A，我们的结果表明，与使用肉眼评估溃疡大小（W = 0.80）相比，使用评估工具评估溃疡大小（W = 0.84）时观察者之间的一致性更高。这与测量B形成对比，测量B在视觉上评估溃疡大小时观察者之间的一致性更高（W = 0.75），而使用测量工具时（W = 0.73）。但是，在视觉评估和测量工具中，测量A和B之间没有统计学上的显着差异（p = 0.000）。

结论

使用CCE进行的CD溃疡大小的常规视觉估计与测量工具一样准确。此外，阅读者之间的一致性通过测量工具和视觉估计的高度观察者间一致性得到了证明。鉴于使用较旧的软件进行了十年的胶囊研究，而没有可用的测量工具，这一新颖的发现令人放心。应该进行进一步的研究，以评估和巩固评估工具在评估具有多种病变的CD的溃疡和黏膜愈合方面的有效性。