Development and reliability of the new endoscopic virtual chromoendoscopy score: the PICaSSO (Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis
Development and reliability of the new endoscopic virtual chromoendoscopy score: the PICaSSO (Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis
复制标题
DOI：
10.1016/j.gie.2017.03.012
复制
发表时间：
2017-12-01
影响因子：
7.7
通讯作者：
Kiesslich, Ralf
中科院分区：
文献类型：
--
作者：
Iacucci, Marietta;Daperno, Marco;Kiesslich, Ralf
背景和目的：内镜下炎症和愈合是溃疡性结肠炎（UC）的重要治疗终点。我们开发并验证了一种新的电子虚拟色素内窥镜 (EVC) 评分，该评分可以反映 UC 中粘膜和血管变化的全谱，包括粘膜愈合。方法：8 名参与者回顾了 60 分钟的培训模块，该模块概述了 3 种不同的 i-SCAN 模式，展示了 UC 中炎症粘膜和血管变化的全谱。通过使用测试前（测试前）和测试后（测试后）的 20 个视频片段，评估内窥镜评分和使用 EVC (i-SCAN) 预测组织学炎症的性能特征。分别对帕丁顿国际虚拟色素内窥镜评分 (PICaSSO) 粘膜和血管评分的协变量进行探索性单变量因子分析。随后，分析了用于预测组织学评分的比例优势逻辑回归模型。 结果：在预测试（kappa = .85；95% CI，.78-.90）和后测试（kappa = .85；95% CI，.77-.90）评估中，观察者间 Mayo 内镜评分的一致性非常好。测试前和测试后评分观察者间一致性中的溃疡性结肠炎内镜严重度指数也是如此（分别为 kappa = .86；95% CI，0.77-.92；kappa = .84；95% CI，0.75-.91）。在测试前和测试后评估中，PICaSSO 内窥镜评分的观察者间一致性非常好（分别为 kappa = .92；95% CI，0.87-.96；kappa = .89；95% CI，0.84-.94）。总体 PICaSSO 通过 Harpaz 评分评估组织学异常和炎症的准确性为 57%（95% CI，48%-65%），通过 Robarts 组织学指数评估为 72%（95% CI，64%-79%），通过程度、慢性性、活动性和附加系统（全谱组织学变化）评估为 83%（95% CI， 76%-88%)。结论：EVC 评分“PICaSSO”显示出非常好的观察者间一致性。新的 EVC 评分可用于定义 UC 粘膜和血管愈合的内镜检查结果，并反映全方位的组织学变化。
Background and Aims: Endoscopic inflammation and healing are important therapeutic endpoints in ulcerative colitis (UC). We developed and validated a new electronic virtual chromoendoscopy (EVC) score that could reflect the full spectrum of mucosal and vascular changes including mucosal healing in UC.Methods: Eight participants reviewed a 60-minute training module outlining 3 different i-SCAN modes demonstrating the entire spectrum of inflammatory mucosal and vascular changes in UC. Performance characteristics in endoscopic scoring and predicting the histologic inflammation with EVC (i-SCAN) by using 20 video clips before (pre-test) and after (post-test) were evaluated. Exploratory univariate factor analysis was performed on Paddington International Virtual Chromoendoscopy Score (PICaSSO) covariates for mucosal and vascular score separately. Subsequently, a proportional odds logistic regression model for the prediction of histologic scores was analyzed.Results: The interobserver agreement for Mayo endoscopic score in the pre-test (kappa = .85; 95% CI, .78-.90) and the post-test (kappa = .85; 95% CI, .77-.90) evaluation were very good. This was also true for the Ulcerative Colitis Endoscopic Index of Severity in the pre-test and post-test score interobserver agreement (kappa = .86; 95% CI, .77-.92; and kappa = .84; 95% CI, .75-.91, respectively). The interobserver agreement of the PICaSSO endoscopic score was very good in the pre-test and post-test evaluations (kappa = .92; 95% CI, .87-.96; and kappa = .89; 95% CI, .84-.94, respectively). The accuracy of the overall PICaSSO in assessing histologic abnormalities and inflammation by Harpaz score was 57% (95% CI, 48%-65%), by Robarts Histological Index 72% (95% CI, 64%-79%), and by the extent, chronicity, activity, plus system (full spectrum of histologic changes) 83% (95% CI, 76%-88%).Conclusions: The EVC score "PICaSSO" showed very good interobserver agreement. The new EVC score may be used to define the endoscopic findings of mucosal and vascular healing in UC and reflected the full spectrum of histologic changes.