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Reliability and Responsiveness of Endoscopic Indices for Assessing Crohn's Disease Postoperative Recurrence in the
Jurij Hanzel1, Sudheer K Vuyyuru2, Brian Bressler3
1Department of Gastroenterology, UMC Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia; Alimentiv, London, Ontario, Canada.
Background & Aims:
Assessing endoscopic activity is integral in the management of postoperative Crohn's disease (CD). We aimed to comprehensively characterize the reliability and responsiveness of different endoscopic instruments when used to assess postoperative CD activity.
Methods:
Ileocolonoscopy videos (n = 70) from the PREVENT (Prospective, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial Comparing REMICADE ® [infliximab] and Placebo in the Prevention of Recurrence in Crohn's Disease Patients Undergoing Surgical Resection Who Are at an Increased Risk of Recurrence) trial were reviewed by 3 blinded central readers. Disease activity was assessed using the Rutgeerts and modified Rutgeerts scores, POCER (postoperative Crohn's endoscopic recurrence) index, REMIND (groupe de REcherche sur les Maladies INflammatoires Digestives) score, Simple Endoscopic Score for Crohn's Disease (SES-CD), and the Crohn's Disease Endoscopic Index of Severity (CDEIS). Reliability was quantified by the intraclass correlation coefficient (ICC). Responsiveness was quantified using the win probability (WinP) defined as the probability that a patient in the treatment (infliximab) group had a better score than a patient in the placebo group. The neoterminal ileum, anastomosis, and distal colon were scored separately.
Results:
Interrater reliability was substantial for the Rutgeerts and modified Rutgeerts scores, ileal REMIND score, SES-CD, and CDEIS (ICC 0.74-0.80), moderate for the POCER index (ICC 0.49), and fair for the anastomotic REMIND score (ICC 0.30). A large degree of responsiveness was observed for the Rutgeerts and modified Rutgeerts scores, ileal REMIND score, SES-CD, and CDEIS (WinP 0.75-0.83). The degree of responsiveness for the POCER index and the anastomotic REMIND score was small (WinP 0.54 and 0.53, respectively). Estimates of index reliability and responsiveness were consistently lower when assessed at the anastomosis or distal colonic segment compared with the neoterminal ileum.
Conclusions:
Existing endoscopic indices are reliable and responsive for assessing postoperative CD activity in the neoterminal ileum, although are suboptimal for evaluation in the anastomosis or distal colonic segment.
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