Scoring Endoscopy in Pediatric Inflammatory Bowel Disease

Abstract

There are a large interobserver variability in evaluating mucosal lesions of inflammatory bowel disease (IBD), especially in pediatric patients. This multicenter prospective observational study aims to evaluate interobserver agreement (IOA) among pediatric endoscopists in assigning validated IBD endoscopic scores in children. Fifteen videos of follow-up ileocolonoscopies in children with IBD were recorded and selected as cases. Eleven pediatric endoscopists from different centers blindly evaluated all videos and calculated scores: either Ulcerative Colitis Endoscopic Index of Severity (UCEIS) or simple endoscopic score for Crohn's Disease (SES-CD). Scores from all reviewer were compared in order to calculate IOA for general videos and specific sections. Scores from an expert adult reader were used to calculate possible reviewer's characteristics affecting scores reliability. Intraclass correlation was 0.298 (95% CI: 0.13-0.55) for UC and 0.266 (0.11-0.52) for CD. When a disease activity categorization was adopted (remission, mild, moderate, severe activity) Fleiss' kappa coefficient was 0.408 (0.29-0.53) for UC and 0.552 (0.43-0.73) for CD. When stratified by item, vascular pattern of UC was the most reliable item IC: 0.624 (0.321-0.854). In multivariable analysis none of the reviewer's characteristics affected the readers' errors. This multicenter study shows low agreement among pediatric endoscopists in evaluating endoscopic scores in children with IBD. By using disease activity categorization, agreement slightly increased, mostly for CD. All readers showed a low-grade concordance with the expert adult gastroenterologist's evaluations. Future specific training programs should be considered to increase interobserver agreement in using IBD endoscopic activity scores.