Is the Mucosal Inflammation in Ulcerative Colitis Assessed Equally on Videos and Photos?

Abstract

Background and Study Aims: The colonoscopy is essential in evaluating the disease activity in ulcerative colitis. Previous studies have shown significant deficiencies in the description of endoscopic findings in medical reports. Previous studies have also shown substantial inter-observer variance in the assessments of endoscopic findings of ulcerative colitis. Systematic image documentation of the endoscopies might add valuable information to the reports. The aim of this study was to evaluate if the severity of mucosal inflammation in ulcerative colitis might be assessed equally well by a still image from the most distal part of a colonic segment as by a video clip from the entire segment, and also to evaluate the intra-observer agreement and the repeatability of the inflammation score. Materials and Methods: Eighteen videos and their corresponding photos visualising different severity of ulcerative colitis were shown randomly to twenty very experienced endoscopists. They assessed the mucosal inflammation of each video clip/photo according to the endoscopic activity index (EAI) on a 10 cm visual analogue scale (VAS). All the images were shown twice to the observers with an interval of at least 4 weeks between the two sessions. 1437 observations were recorded. Results: There was no significant difference in the mean score of the inflammation between video clips and the corresponding photo in all degree of inflammation. There was neither any significant difference between the repeatability and the intra-observer agreement between the first and second scores of videos and photos. Conclusion The mucosal inflammation in ulcerative colitis might be documented as well with an image from the most distal part of each segment as a video clip from the segment. Systematic image documentation of ulcerative colitis with still images might represent an important contribution to a more precise description of the endoscopic findings.