The Paddington International Virtual Chromoendoscopy Score in ulcerative colitis exhibits very good inter-rater agreement after computerized module training: a multicentre study across academic and community practice (with video)

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The Paddington International Virtual Chromoendoscopy Score in ulcerative colitis exhibits very good inter-rater agreement after computerized module training: a multicentre study across academic and community practice (with video). / Trivedi, Palak; Kiesslich, Ralf; Hodson, James; Bhala, Neeraj; Boulton, Ralph; Cooney, Rachel; Gui, Xianyong; Iqbal, Tariq; Li, Ka-Kit; Mumtaz, Saqib; Pathmakanthan, Shri; Quraishi, Mohammed Nabil; Sagar, Vandana; Shah, Ashit; Sharma, Naveen; Siau, Keith; Smith, Samuel; Ward, Stephen; Widlak, Monika M.; Bisschops, Raf; Ghosh, Subrata; Iacucci, Marietta.

In: Gastrointestinal Endoscopy, Vol. 88, No. 1, 07.2018, p. 95-106.e2.

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@article{0deb0fe5bac14de3afddfe5a2262938d,
title = "The Paddington International Virtual Chromoendoscopy Score in ulcerative colitis exhibits very good inter-rater agreement after computerized module training:: a multicentre study across academic and community practice (with video)",
abstract = "Introduction: Electronic virtual chromoendoscopy (EVC) can demonstrate ongoing disease activity in ulcerative colitis (UC) even when Mayo subscores suggest healing. However, applicability of EVC technology outside the expert setting has yet to be determined.Methods: 15 participants across five centres reviewed a computerised training module outlining high definition (HD) and EVC (i-Scan) colonoscopy modes. Inter-observer agreement was then tested (Mayo score, UCEIS and the Paddington International virtual ChromoendoScopy ScOre [PICaSSO] for UC), using a colonoscopy video library (n=30 cases reviewed pre- and n=30 post-training). Knowledge sustainability was re-tested in a second round (n=42 cases; 9/15 participants), 6 months post-training provision.Results: Pre-training intraclass correlation coefficients (ICC) were good for the Mayo endoscopic subscore (ICC:0.775), UCEIS scoring erosions/ulcers (ICC:0.770) and UCEIS overall (ICC:0.786), and for mucosal (ICC:0.754) and vascular components of PICaSSO (ICC:0.622). For the vascular components of UCEIS, agreement was only moderate (ICC:0.429), and did not enhance post-training (ICC:0.417); unlike for PICaSSO which improved (mucosal ICC:0.848; vascular: 0.746). Histological correlation using the New York Mt. Sinai System was strong for both PICaSSO components (Spearman{\textquoteright}s rho for mucosal: 0.925, and vascular: 0.873; p<0.001 for both). Moreover, accuracy in specifically discriminating quiescent from mild histological strata was strongest for PICaSSO (AUROC for mucosal: 0.781; vascular: 0.715), compared to Mayo (AUROC:0.708) and UCEIS (AUROC for UCEIS overall: 0.705; vascular: 0.562; bleeding: 0.645; erosions/ulcers: 0.696). Inter-rater reliability for PICaSSO was sustained by round two participants (Round 1 and 2 ICC for mucosal: 0.873 and 0.869,respectively; and vascular: 0.715 and 0.783, respectively), together with histological correlation (rho mucosal: 0.934, vascular: 0.938; p<0.001 for both).Conclusion: PICaSSO demonstrates good inter-observer agreement across all levels of experience, providing excellent correlation with histology. Given ability to discriminate subtle endoscopic features, PICaSSO may be applied to refine stratified treatment paradigms for UC patients.",
keywords = "colonoscopy , endoscopic remission , histological remission , inflammatory bowel disease, mucosal healing , risk stratification",
author = "Palak Trivedi and Ralf Kiesslich and James Hodson and Neeraj Bhala and Ralph Boulton and Rachel Cooney and Xianyong Gui and Tariq Iqbal and Ka-Kit Li and Saqib Mumtaz and Shri Pathmakanthan and Quraishi, {Mohammed Nabil} and Vandana Sagar and Ashit Shah and Naveen Sharma and Keith Siau and Samuel Smith and Stephen Ward and Widlak, {Monika M.} and Raf Bisschops and Subrata Ghosh and Marietta Iacucci",
note = "Copyright {\textcopyright} 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.",
year = "2018",
month = jul,
doi = "10.1016/j.gie.2018.02.044",
language = "English",
volume = "88",
pages = "95--106.e2",
journal = "Gastrointestinal Endoscopy",
issn = "0016-5107",
publisher = "Elsevier",
number = "1",

}

RIS

TY - JOUR

T1 - The Paddington International Virtual Chromoendoscopy Score in ulcerative colitis exhibits very good inter-rater agreement after computerized module training:

T2 - a multicentre study across academic and community practice (with video)

AU - Trivedi, Palak

AU - Kiesslich, Ralf

AU - Hodson, James

AU - Bhala, Neeraj

AU - Boulton, Ralph

AU - Cooney, Rachel

AU - Gui, Xianyong

AU - Iqbal, Tariq

AU - Li, Ka-Kit

AU - Mumtaz, Saqib

AU - Pathmakanthan, Shri

AU - Quraishi, Mohammed Nabil

AU - Sagar, Vandana

AU - Shah, Ashit

AU - Sharma, Naveen

AU - Siau, Keith

AU - Smith, Samuel

AU - Ward, Stephen

AU - Widlak, Monika M.

AU - Bisschops, Raf

AU - Ghosh, Subrata

AU - Iacucci, Marietta

N1 - Copyright © 2018 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved.

PY - 2018/7

Y1 - 2018/7

N2 - Introduction: Electronic virtual chromoendoscopy (EVC) can demonstrate ongoing disease activity in ulcerative colitis (UC) even when Mayo subscores suggest healing. However, applicability of EVC technology outside the expert setting has yet to be determined.Methods: 15 participants across five centres reviewed a computerised training module outlining high definition (HD) and EVC (i-Scan) colonoscopy modes. Inter-observer agreement was then tested (Mayo score, UCEIS and the Paddington International virtual ChromoendoScopy ScOre [PICaSSO] for UC), using a colonoscopy video library (n=30 cases reviewed pre- and n=30 post-training). Knowledge sustainability was re-tested in a second round (n=42 cases; 9/15 participants), 6 months post-training provision.Results: Pre-training intraclass correlation coefficients (ICC) were good for the Mayo endoscopic subscore (ICC:0.775), UCEIS scoring erosions/ulcers (ICC:0.770) and UCEIS overall (ICC:0.786), and for mucosal (ICC:0.754) and vascular components of PICaSSO (ICC:0.622). For the vascular components of UCEIS, agreement was only moderate (ICC:0.429), and did not enhance post-training (ICC:0.417); unlike for PICaSSO which improved (mucosal ICC:0.848; vascular: 0.746). Histological correlation using the New York Mt. Sinai System was strong for both PICaSSO components (Spearman’s rho for mucosal: 0.925, and vascular: 0.873; p<0.001 for both). Moreover, accuracy in specifically discriminating quiescent from mild histological strata was strongest for PICaSSO (AUROC for mucosal: 0.781; vascular: 0.715), compared to Mayo (AUROC:0.708) and UCEIS (AUROC for UCEIS overall: 0.705; vascular: 0.562; bleeding: 0.645; erosions/ulcers: 0.696). Inter-rater reliability for PICaSSO was sustained by round two participants (Round 1 and 2 ICC for mucosal: 0.873 and 0.869,respectively; and vascular: 0.715 and 0.783, respectively), together with histological correlation (rho mucosal: 0.934, vascular: 0.938; p<0.001 for both).Conclusion: PICaSSO demonstrates good inter-observer agreement across all levels of experience, providing excellent correlation with histology. Given ability to discriminate subtle endoscopic features, PICaSSO may be applied to refine stratified treatment paradigms for UC patients.

AB - Introduction: Electronic virtual chromoendoscopy (EVC) can demonstrate ongoing disease activity in ulcerative colitis (UC) even when Mayo subscores suggest healing. However, applicability of EVC technology outside the expert setting has yet to be determined.Methods: 15 participants across five centres reviewed a computerised training module outlining high definition (HD) and EVC (i-Scan) colonoscopy modes. Inter-observer agreement was then tested (Mayo score, UCEIS and the Paddington International virtual ChromoendoScopy ScOre [PICaSSO] for UC), using a colonoscopy video library (n=30 cases reviewed pre- and n=30 post-training). Knowledge sustainability was re-tested in a second round (n=42 cases; 9/15 participants), 6 months post-training provision.Results: Pre-training intraclass correlation coefficients (ICC) were good for the Mayo endoscopic subscore (ICC:0.775), UCEIS scoring erosions/ulcers (ICC:0.770) and UCEIS overall (ICC:0.786), and for mucosal (ICC:0.754) and vascular components of PICaSSO (ICC:0.622). For the vascular components of UCEIS, agreement was only moderate (ICC:0.429), and did not enhance post-training (ICC:0.417); unlike for PICaSSO which improved (mucosal ICC:0.848; vascular: 0.746). Histological correlation using the New York Mt. Sinai System was strong for both PICaSSO components (Spearman’s rho for mucosal: 0.925, and vascular: 0.873; p<0.001 for both). Moreover, accuracy in specifically discriminating quiescent from mild histological strata was strongest for PICaSSO (AUROC for mucosal: 0.781; vascular: 0.715), compared to Mayo (AUROC:0.708) and UCEIS (AUROC for UCEIS overall: 0.705; vascular: 0.562; bleeding: 0.645; erosions/ulcers: 0.696). Inter-rater reliability for PICaSSO was sustained by round two participants (Round 1 and 2 ICC for mucosal: 0.873 and 0.869,respectively; and vascular: 0.715 and 0.783, respectively), together with histological correlation (rho mucosal: 0.934, vascular: 0.938; p<0.001 for both).Conclusion: PICaSSO demonstrates good inter-observer agreement across all levels of experience, providing excellent correlation with histology. Given ability to discriminate subtle endoscopic features, PICaSSO may be applied to refine stratified treatment paradigms for UC patients.

KW - colonoscopy

KW - endoscopic remission

KW - histological remission

KW - inflammatory bowel disease

KW - mucosal healing

KW - risk stratification

U2 - 10.1016/j.gie.2018.02.044

DO - 10.1016/j.gie.2018.02.044

M3 - Article

C2 - 29548940

VL - 88

SP - 95-106.e2

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

SN - 0016-5107

IS - 1

ER -