Principi Mariabeatrice, Contaldo Antonella, Bianchi Francesco Paolo, Losurdo Giuseppe, Iannone Andrea, Ierardi Enzo, Tafuri Silvio, Di Leo Alfredo
Section of Gastroenterology, Department of Emergency and Organ Transplantation, University "Aldo Moro" of Bari, 70124 Bari, Italy.
Department of Biomedical Science and Human Oncology, University of Bari "Aldo Moro", 70124 Bari, Italy.
Diagnostics (Basel). 2020 Apr 12;10(4):213. doi: 10.3390/diagnostics10040213.
Ulcerative colitis (UC) endoscopic scores translate mucosal damage into values standardizing image analysis. Due to potential limits of current endoscopic activity indexes, we have elaborated on a new score, the "Extended Mayo Endoscopic Score (EMES)," and evaluated its inter-observer agreement in a multicenter endoscopy team, comparing concordance with the Mayo subscore. Sixteen UC consecutive patients underwent follow-up colonoscopy. Recorded videos were anonymously loaded on a web platform. Thirteen expert endoscopists evaluated UC activity using both Mayo and EMES. EMES was described in every colon segment: erythema (0: absent, 1: mild, 2: moderate, 3: severe), vascular pattern (0: normal, 1: reduction, 2: disappearance), erosions and ulcers (0: absent, 1: from 1 to 5, 2: 6 to 10, 3: >10). Weighted Fleiss' kappa with 95% confidence interval (CI) and -value defined inter-rater agreement. Global inter-observer agreement of EMES was moderate (kappa = 0.56, 95% CI = 0.46-0.67, < 0.001). The evaluation of each colonic segment showed moderate agreement for all segments: ascending (kappa = 0.46, 95% CI = 0.32-0.60, < 0.001), transverse (kappa = 0.48, 95% CI = 0.29-0.67, < 0.001); descending (kappa = 0.49, 95% CI = 0.35-0.64, < 0.001), sigmoid (kappa = 0.52, 95% CI = 0.39-0.65, < 0.001) and rectum (kappa = 0.55, 95% CI = 0.42-0.69, < 0.001). Mayo subscore agreement was similar to global EMES (kappa = 0.53, 95% CI = 0.39-0.66, = 0.001). Therefore, our report emphasizes the importance of assessing inter-observer agreement for EMES, but also for other known scoring systems, including the Mayo subscore.
溃疡性结肠炎（UC）内镜评分将黏膜损伤转化为标准化图像分析的值。由于当前内镜活动指数存在潜在局限性，我们制定了一种新的评分系统，即“扩展梅奥内镜评分（EMES）”，并在一个多中心内镜团队中评估了其观察者间的一致性，同时与梅奥子评分进行了一致性比较。16例连续性UC患者接受了随访结肠镜检查。记录的视频被匿名上传至一个网络平台。13名内镜专家使用梅奥评分和EMES对UC活动进行评估。EMES对每个结肠段进行描述：红斑（0：无，1：轻度，2：中度，3：重度）、血管形态（0：正常，1：减少，2：消失）、糜烂和溃疡（0：无，1：1至5个，2：6至10个，3：>10个）。使用95%置信区间（CI）的加权Fleiss' kappa和P值来定义评分者间的一致性。EMES的整体观察者间一致性为中等（kappa = 0.56，95% CI = 0.46 - 0.67，P < 0.001）。对每个结肠段的评估显示所有段的一致性均为中等：升结肠（kappa = 0.46，95% CI = 0.32 - 0.60，P < 0.001）、横结肠（kappa = 0.48，95% CI = 0.29 - 0.67，P < 0.001）、降结肠（kappa = 0.49，95% CI = 0.35 - 0.64，P < 0.001）、乙状结肠（kappa = 0.52，95% CI = 0.39 - 0.65，P < 0.001）和直肠（kappa = 0.55，95% CI = 0.42 - 0.69，P < 0.001）。梅奥子评分的一致性与EMES整体相似（kappa = 0.53，95% CI = 0.39 - 0.66，P = 0.001）。因此，我们的报告强调了评估EMES观察者间一致性的重要性，同时也强调了评估包括梅奥子评分在内的其他已知评分系统观察者间一致性的重要性。
