Abstract：
OBJECTIVE: 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, 2 new scores have been proposed. This study assessed the interobserver agreement of the current score (mRS) and the new endoscopic score for ePOR in CD.
METHODS: Sixteen Dutch academic and nonacademic inflammatory bowel disease specialists assessed endoscopic videos (n = 71) of postoperative CD patients (n = 66) retrieved from 9 Dutch centers. Each video was assessed for degree of inflammation by 4 gastroenterologists using the mRS and the new proposed endoscopic score: the REMIND score (separate score of anastomosis and neoterminal ileum) and the 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, and colonic and/or ileal blind loop were separately assessed. Interobserver agreement was assessed by using Fleiss\' weighted kappa.
RESULTS: Fleiss\' weighted kappa for the mRS was .67 (95% confidence interval [CI], .59-.74). The weighted kappa for the REMIND score was .73 (95% CI, .65-.80) for lesions in the neoterminal ileum and .46 (95% CI, .35-.58) for anastomotic lesions. The weighted kappa for the updated Rutgeerts score was .69 (95% CI, .62-.77). The weighted kappa for lesions in the ileal body, ileal inlet, neoterminal ileum, and colonic and ileal blind loop was .61 (95% CI, .49-.73), .63 (95% CI, .54-.72), .61 (95% CI, .49-.74), .83 (95% CI, .62-1.00) and .68 (95% CI, .46-.89), respectively.
CONCLUSIONS: 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, although only moderate for anastomotic lesions. Because 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.
METHODS: Sixteen Dutch academic and nonacademic inflammatory bowel disease specialists assessed endoscopic videos (n = 71) of postoperative CD patients (n = 66) retrieved from 9 Dutch centers. Each video was assessed for degree of inflammation by 4 gastroenterologists using the mRS and the new proposed endoscopic score: the REMIND score (separate score of anastomosis and neoterminal ileum) and the 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, and colonic and/or ileal blind loop were separately assessed. Interobserver agreement was assessed by using Fleiss\' weighted kappa.
RESULTS: Fleiss\' weighted kappa for the mRS was .67 (95% confidence interval [CI], .59-.74). The weighted kappa for the REMIND score was .73 (95% CI, .65-.80) for lesions in the neoterminal ileum and .46 (95% CI, .35-.58) for anastomotic lesions. The weighted kappa for the updated Rutgeerts score was .69 (95% CI, .62-.77). The weighted kappa for lesions in the ileal body, ileal inlet, neoterminal ileum, and colonic and ileal blind loop was .61 (95% CI, .49-.73), .63 (95% CI, .54-.72), .61 (95% CI, .49-.74), .83 (95% CI, .62-1.00) and .68 (95% CI, .46-.89), respectively.
CONCLUSIONS: 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, although only moderate for anastomotic lesions. Because 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.
摘要：
目的：改良Rutgeerts评分（mRS）广泛用于评估回结肠切除术后克罗恩病（CD）的内镜术后复发（ePOR），以指导治疗决策。为了提高这种内镜评估的有效性和预后价值，提出了两个新的分数。这项研究评估了当前（mRS）和新的内窥镜评分对CD中ePOR的观察者之间的一致性。
方法：16位荷兰学术和非学术IBD专家评估了从9个荷兰中心检索的术后CD患者（n=66）的内镜录像（n=71）。四个胃肠病学家使用mRS和新提议的内窥镜评分评估每个视频的炎症程度：REMIND评分（吻合和新末端回肠的单独评分）和更新的Rutgeerts评分（吻合线的病变评估，回肠入口,回肠体和新回肠)。此外,回肠体的病变,回肠入口,新发回肠，分别评估结肠和/或回肠盲环.使用Fleiss\'加权kappa评估了观察员之间的协议。
结果：MRS的Fleiss\'加权κ为0.67（95%置信区间[CI]0.59-0.74）。新末端回肠病变的REMIND评分加权κ为0.73（95％CI0.65-0.80），吻合口病变为0.46（95％CI0.35-0.58）。更新的Rutgeerts评分的加权kappa为0.69（95%CI0.62-0.77）。回肠体病变的加权κ，回肠入口,新发回肠，结肠和回肠盲环为0.61（95%CI0.49-0.73），0.63（95%CI0.54-0.72），0.61（95%CI0.49-0.74），0.83（95%CI0.62-1.00）和0.68（95%CI0.46-0.89）。
结论：mRS的观察者间协议是实质性的。同样，观察员之间的协议对于更新的Rutgeerts分数是实质性的。根据REMIND评分,对于新回肠的病变，观察者之间的共识是实质性的，而仅中度吻合口病变。由于临床实践中的治疗决策是基于这些评估，并且这些评分在临床研究中用作结果度量，进一步完善观察员间协定至关重要。
方法：16位荷兰学术和非学术IBD专家评估了从9个荷兰中心检索的术后CD患者（n=66）的内镜录像（n=71）。四个胃肠病学家使用mRS和新提议的内窥镜评分评估每个视频的炎症程度：REMIND评分（吻合和新末端回肠的单独评分）和更新的Rutgeerts评分（吻合线的病变评估，回肠入口,回肠体和新回肠)。此外,回肠体的病变,回肠入口,新发回肠，分别评估结肠和/或回肠盲环.使用Fleiss\'加权kappa评估了观察员之间的协议。
结果：MRS的Fleiss\'加权κ为0.67（95%置信区间[CI]0.59-0.74）。新末端回肠病变的REMIND评分加权κ为0.73（95％CI0.65-0.80），吻合口病变为0.46（95％CI0.35-0.58）。更新的Rutgeerts评分的加权kappa为0.69（95%CI0.62-0.77）。回肠体病变的加权κ，回肠入口,新发回肠，结肠和回肠盲环为0.61（95%CI0.49-0.73），0.63（95%CI0.54-0.72），0.61（95%CI0.49-0.74），0.83（95%CI0.62-1.00）和0.68（95%CI0.46-0.89）。
结论：mRS的观察者间协议是实质性的。同样，观察员之间的协议对于更新的Rutgeerts分数是实质性的。根据REMIND评分,对于新回肠的病变，观察者之间的共识是实质性的，而仅中度吻合口病变。由于临床实践中的治疗决策是基于这些评估，并且这些评分在临床研究中用作结果度量，进一步完善观察员间协定至关重要。
