Interobserver agreement of current and new proposed endoscopic scores for postoperative recurrence in Crohn's disease

Michiel T J Bak; Nassim Hammoudi; Matthieu Allez; Mark S Silverberg; Isa M Schellekens; Nicole S Erler; Gerard Dijkstra; Mariëlle Romberg-Camps; Nanne K H de Boer; Sita V Jansen; Sander van der Marel; Carmen S Horjus; Marijn C Visschedijk; Rogier L Goetgebuer; Willemijn A van Dop; Jildou Hoekstra; Alexander G L Bodelier; Ilse Molendijk; Lauranne A A P Derikx; Fiona D M van Schaik; Rachel L West; Marjolijn Duijvestein; C Janneke van der Woude; Oddeke van Ruler; Annemarie C de Vries; Dutch Initiative on Crohn and Colitis and the RAP-CD study group

doi:10.1016/j.gie.2024.03.011

Interobserver agreement of current and new proposed endoscopic scores for postoperative recurrence in Crohn's disease

Gastrointest Endosc. 2024 Mar 8:S0016-5107(24)00164-0. doi: 10.1016/j.gie.2024.03.011. Online ahead of print.

Authors

Michiel T J Bak¹, Nassim Hammoudi², Matthieu Allez², Mark S Silverberg³, Isa M Schellekens¹, Nicole S Erler⁴, Gerard Dijkstra⁵, Mariëlle Romberg-Camps⁶, Nanne K H de Boer⁷, Sita V Jansen⁸, Sander van der Marel⁹, Carmen S Horjus¹⁰, Marijn C Visschedijk⁵, Rogier L Goetgebuer¹¹, Willemijn A van Dop¹², Jildou Hoekstra¹³, Alexander G L Bodelier¹³, Ilse Molendijk¹, Lauranne A A P Derikx¹, Fiona D M van Schaik¹⁴, Rachel L West¹⁵, Marjolijn Duijvestein¹², C Janneke van der Woude¹, Oddeke van Ruler¹⁶, Annemarie C de Vries¹⁷; Dutch Initiative on Crohn and Colitis and the RAP-CD study group

Affiliations

¹ Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
² Gastroenterology Department, Hôpital Saint-Louis - APHP, Université Paris Cité, INSERM U1160, Paris, France.
³ Division of Gastroenterology, Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
⁵ Department of Gastroenterology and Hepatology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
⁶ Department of Gastroenterology, Geriatrics, Internal and Intensive Care Medicine (Co-MIK), Zuyderland Medical Centre, Heerlen-Sittard-Geleen, the Netherlands.
⁷ Department of Gastroenterology and Hepatology, AGEM Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
⁸ Department of Gastroenterology and Hepatology, Reinier de Graaf Groep, Delft, the Netherlands.
⁹ Department of Gastroenterology and Hepatology, Haaglanden Medical Center, The Hague, the Netherlands.
¹⁰ Department of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, the Netherlands.
¹¹ Department of Gastroenterology and Hepatology, Amsterdam University Medical Center, Amsterdam, the Netherlands.
¹² Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
¹³ Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands.
¹⁴ Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, the Netherlands.
¹⁵ Department of Gastroenterology and Hepatology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.
¹⁶ Department of Surgery, IJsselland Hospital, Capelle aan den IJssel, the Netherlands; Department of Surgery, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands.
¹⁷ Department of Gastroenterology and Hepatology, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands. Electronic address: a.c.devries@erasmusmc.nl.

PMID: 38462057
DOI: 10.1016/j.gie.2024.03.011

Abstract

Background and aims: The modified Rutgeerts' score (mRS) is widely used for the assessment of endoscopic postoperative recurrence (ePOR) in Crohn's disease (CD) after ileocolic resection to guide therapeutic decisions. To improve the validity and prognostic value of this endoscopic assessment, two new scores have been proposed. This study assessed the interobserver agreement of the current (mRS) and new endoscopic scores for ePOR in CD.

Methods: Sixteen Dutch academic and non-academic IBD specialists assessed endoscopic videos (n=71) of postoperative CD patients (n=66) retrieved from nine Dutch centers. Each video was assessed for the degree of inflammation by four gastroenterologists using the mRS and the new proposed endoscopic score: REMIND score (separate score of anastomosis and neoterminal ileum) and updated Rutgeerts score (assessment of lesions at the anastomotic line, ileal inlet, ileal body and neoterminal ileum). In addition, lesions at the ileal body, ileal inlet, neoterminal ileum, colonic and/or ileal blind loop were separately assessed. Interobserver agreement was assessed using Fleiss' weighted kappa.

Results: Fleiss' weighted kappa for the mRS was 0.67 (95% confidence interval [CI] 0.59-0.74). The weighted kappa for the REMIND score was 0.73 (95% CI 0.65-0.80) for lesions in the neoterminal ileum and 0.46 (95% CI 0.35-0.58) for anastomotic lesions. The weighted kappa for the updated Rutgeerts' score was 0.69 (95% CI 0.62-0.77). The weighted kappa for lesions in the ileal body, ileal inlet, neoterminal ileum, colonic and ileal blind loop was 0.61 (95% CI 0.49-0.73), 0.63 (95% CI 0.54-0.72), 0.61 (95% CI 0.49-0.74), 0.83 (95% CI 0.62-1.00) and 0.68 (95% CI 0.46-0.89).

Conclusion: The interobserver agreement of the mRS is substantial. Similarly, the interobserver agreement is substantial for the updated Rutgeerts' score. According to the REMIND score, the interobserver agreement was substantial for lesions in the neoterminal ileum, whereas only moderate for anastomotic lesions. Since therapeutic decisions in clinical practice are based on these assessments and these scores are used as outcome measure in clinical studies, further improvement of the interobserver agreement is essential.

Keywords: Crohn’s disease; interobserver agreement; modified Rutgeerts’ score; postoperative endoscopic recurrence.