Marteau Philippe, Laharie David, Colombel Jean-Frédéric, Martin Laurence, Coevoet Hugues, Allez Matthieu, Cadiot Guillaume, Bourreille Arnaud, Carbonnel Franck, Bouhnik Yoram, Coffin Benoit, Duclos Bernard, Dupas Jean Louis, Moreau Jacques, Louis Edouard, Mary Jean-Yves
Service d'Hépatogastroentérologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris cedex, France Denis Diderot - Paris7 University, Paris, France.
CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie - Université Bordeaux, Laboratoire de bactériologie, F-33000 Bordeaux, Pessac, France
J Crohns Colitis. 2016 Sep;10(9):1001-5. doi: 10.1093/ecco-jcc/jjw082. Epub 2016 Apr 11.
After resection surgery for Crohn's disease, recurrence of endoscopic lesions at the site of the anastomosis or in the neoterminal ileum is graded according to the Rutgeerts score (RS). The goal of this study was to test the interobserver variability for RS.
Thirteen trained endoscopists evaluated the RS on 39 videotapes of patients who had undergone resection for Crohn's disease with an ileocolonic anastomosis 6 months earlier. Videotapes were randomly assigned to endoscopists through a balanced incomplete block design. Each videotape was scored independently by four endoscopists, and each endoscopist evaluated 12 videotapes, making a total of 156 videotape assessments. Reproducibility levels of the RS were assessed through unweighted kappa estimates among multiple raters. The proportion of inappropriate therapeutic initiation was estimated by randomly selecting one endoscopist for each videorecording, assuming that the majority of endoscopists correctly classified endoscopic recurrence.
The kappa estimates were 0.43 (95% confidence interval: 0.33-0.52) for the RS on a 5-grade scale, 0.47 (0.28-0.66) for RS < i2 vs. ≥ i2, and 0.64 (0.42-0.85) for RS ≤ i2 vs. > i2. The percentages of inappropriate therapeutic initiation were 12.8% (3.8-21.9) when initiation was triggered by a RS ≥ i2 and 8.3% (1.1-15.6) when initiation was triggered by a RS > i2 (p = 0.41).
The reproducibility of the RS was moderate, especially when differentiating <i2 from ≥i2, which may lead to incorrect therapeutic decisions in >10% of patients.
克罗恩病切除术后，吻合口或新末端回肠处内镜下病变的复发情况根据 Rutgeerts 评分（RS）进行分级。本研究的目的是测试 RS 的观察者间变异性。
13 名经过培训的内镜医师对 39 份 6 个月前接受过克罗恩病回结肠吻合术切除的患者的录像带进行 RS 评估。录像带通过平衡不完全区组设计随机分配给内镜医师。每份录像带由 4 名内镜医师独立评分，每位内镜医师评估 12 份录像带，共进行 156 次录像带评估。通过多个评分者之间的未加权卡帕估计来评估 RS 的可重复性水平。假设大多数内镜医师能正确分类内镜复发情况，通过为每份录像记录随机选择一名内镜医师来估计不适当治疗起始的比例。
5 级评分的 RS 的卡帕估计值为 0.43（95%置信区间：0.33 - 0.52），RS < i2 与≥i2 比较的卡帕估计值为 0.47（0.28 - 0.66），RS ≤ i2 与> i2 比较的卡帕估计值为 0.64（0.42 - 0.85）。当 RS ≥ i2 触发治疗起始时，不适当治疗起始的百分比为 12.8%（3.8 - 21.9），当 RS > i2 触发治疗起始时，不适当治疗起始的百分比为 8.3%（1.1 - 15.6）（p = 0.41）。
RS 的可重复性为中等，尤其是在区分< i2 与≥i2 时，这可能导致超过 10%的患者出现错误的治疗决策。
