Cotter José, Dias de Castro Francisca, Magalhães Joana, Moreira Maria João, Rosa Bruno
Gastroenterology Department, Centro Hospitalar do Alto Ave, Guimarães, Portugal.
Endoscopy. 2015 Apr;47(4):330-5. doi: 10.1055/s-0034-1390894. Epub 2014 Nov 20.
The Lewis score was developed to measure mucosal inflammatory activity as detected by small-bowel capsule endoscopy (SBCE). The aim of the current study was to validate the Lewis score by assessing interobserver correlation and level of agreement in a clinical setting.
This was a retrospective, single-center, double-blind study including patients with isolated small-bowel Crohn's disease who underwent SBCE. The Lewis score was calculated using a software application, based on the characteristics of villous edema, ulcers, and stenoses. The Lewis score was independently calculated by one of three investigators and by a central reader (gold standard). Interobserver agreement was assessed using intraclass correlation (ICC) coefficient and Bland - Altman plots.
A total of 70 patients were consecutively included (mean age 33.9 ± 11.7 years). The mean Lewis score was 1265 and 1320 for investigators and the central reader, respectively. There was a high correlation, both for scores obtained for each tertile (first tertile r = 0.659 - 0.950, second tertile r = 0.756 - 0.906, third tertile r = 0.750 - 0.939), and for the global score (r = 0.745 - 0.928) (P < 0.0001). Interobserver agreement was almost perfect between the investigators and the central reader (first tertile ICC = 0.788 - 0.971, second tertile ICC = 0.824 - 0.943, third tertile ICC = 0.857 - 0.968, global score ICC = 0.852 - 0.960; P < 0.0001). The inflammatory activity was classified as normal (score < 135) in 2.9 % vs. 2.9 %, mild (score ≥ 135 - < 790) in 51.4 % vs. 55.7 %, and moderate to severe (score ≥ 790) in 45.8 % vs. 41.4 % of patients, respectively (P < 0.001).
A strong interobserver agreement was demonstrated for the determination of the Lewis score in a practical clinical setting, validating this score for the reporting of small-bowel inflammatory activity. The Lewis score might be used for diagnosing, staging, follow-up, and therapeutic assessment of patients with isolated small-bowel Crohn's disease.
Lewis评分用于衡量小肠胶囊内镜（SBCE）检测到的黏膜炎症活动。本研究的目的是通过评估临床环境中的观察者间相关性和一致性水平来验证Lewis评分。
这是一项回顾性、单中心、双盲研究，纳入了接受SBCE的孤立性小肠克罗恩病患者。基于绒毛水肿、溃疡和狭窄的特征，使用软件应用程序计算Lewis评分。Lewis评分由三名研究者之一和一名中心阅片者（金标准）独立计算。使用组内相关系数（ICC）和Bland - Altman图评估观察者间的一致性。
共连续纳入70例患者（平均年龄33.9±11.7岁）。研究者和中心阅片者的平均Lewis评分分别为1265和1320。每个三分位数的评分（第一个三分位数r = 0.659 - 0.950，第二个三分位数r = 0.756 - 0.906，第三个三分位数r = 0.750 - 0.939）以及总体评分（r = 0.745 - 0.928）均具有高度相关性（P < 0.0001）。研究者与中心阅片者之间的观察者间一致性几乎完美（第一个三分位数ICC = 0.788 - 0.971，第二个三分位数ICC = 0.824 - 0.943，第三个三分位数ICC = 0.857 - 0.968，总体评分ICC = 0.852 - 0.960；P < 0.0001）。炎症活动分别被分类为正常（评分<135）的患者占2.9%对2.9%，轻度（评分≥135 - <790）的患者占51.4%对55.7%，中度至重度（评分≥790）的患者占45.8%对41.4%（P < 0.001）。
在实际临床环境中，对于Lewis评分的测定显示出很强的观察者间一致性，验证了该评分在报告小肠炎症活动方面的有效性。Lewis评分可用于孤立性小肠克罗恩病患者的诊断、分期、随访和治疗评估。
