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P151. Recommendations for creating a high quality endoscopy report for inflammatory bowel disease patients: results from a RAND-appropriateness panel

S.M. Devlin1, G.Y. Melmed2, P.M. Irving3, D.T. Rubin4, A. Kornbluth5, P.L. Kozuch6, L.E. Raffals7, F.S. Velayos8, M.P. Sparrow9, L. Baidoo10, B. Bressler11, A.S. Cheifetz12, J. Jones13, G.G. Kaplan1, J. Greene14, C.A. Siegel14, 1The University of Calgary, Gastroenterology, Calgary, Canada, 2Cedars-Sinai Medical Center, Medicine, Los Angeles, United States, 3Guy's & St Thomas' Hospitals, Medicine, London, United Kingdom, 4University of Chicago, Medicine, Chicago, United States, 5Icahn School of Medicine at Mount Sinai, Medicine, New York, United States, 6Jefferson University, Medicine, Philadelphia, United States, 7Mayo Clinic, Gastroenterology, Rochester, United States, 8University of California San Francisco, Gastroenterology, San Francisco, United States, 9The Alfred Hospital, Medicine, Melbourne, Australia, 10University of Pittsburgh, Gastroenterology, Pittsburgh, United States, 11University of British Columbia, Gastroenterology, Vancouver, Canada, 12Beth Israel Deaconess Medical Center, Harvard Medical School, Gastroenterology, Boston, United States, 13University of Saskatchewan, Gastroenterology, Saskatoon, Canada, 14Dartmouth-Hitchcock Medical Center, Gastroenterology, Lebanon, United States

Background

There is no consensus on standardization of endoscopy reporting for patients with inflammatory bowel disease (IBD). Endoscopic disease activity is central to therapeutic decision-making but other details about the procedure are also critical to a comprehensive assessment. Our aim was to develop a template for a high quality endoscopy report for IBD.

Methods

We applied the RAND/UCLA Appropriateness Method to rate the importance and feasibility of elements for inclusion in endoscopy reports for IBD. A literature review was conducted on quality indicators for colonoscopy, polypoid lesions in IBD, endoscopic approach to dysplasia surveillance, endoscopic disease activity indices in IBD, and endoscopy of the ileo-anal pouch. This review was presented to the Building Research in Inflammatory Bowel Disease Globally (BRIDGe) group and two external IBD/endoscopy experts (DR and AK). Next, a review of 106 candidate reporting elements that were proposed initially spanning “disease background”, “findings”, “dysplasia surveillance”, “Crohn's disease with an ileo-colonic anastomosis”, “Crohn's disease with a colo-colonic anastomosis” and “pouchoscopy” was undertaken. Panelists used the modified Delphi method to anonymously rate the importance and feasibility of candidate elements on a 1–9 scale (1–3 not important/feasible, 4–6 moderately important/feasible, 7–9 very important/feasible). Disagreement was assessed using a disagreement index (DI). Panelists met in person to discuss areas of disagreement, followed by a second round of anonymous rating. Elements rated a median of 7 or more on importance were retained.

Results

56 elements were retained, of which six were duplicated in two or more scenarios. Therefore, a total of 50 reporting elements were retained across the four themes of “disease background”, “findings and interventions”, “Crohn's disease with an ileo-colonic anastomosis”, and “pouchoscopy”. Disagreement was noted on 9 elements, of which 3 were included in the model. A summary of representative elements is presented in Table 1.

Table 1 (abstract P151). Summary of main included reporting elements a
Importance ratingFeasibility rating
MedianMeanDisagreement indexMedianMeanDisagreement index
Disease background elements for all IBD procedures
Specific indication for procedure98.50.098.58−0.22
Specific IBD therapy at time of procedure76.91−3.086.56.082.72
Description of symptoms at time of current evaluation77.33−0.7177.42−0.71
Findings and interventions - Perianal examination
Description of pertinent positives/negatives re: stigmata of perianal CD (fissures, fistulas, skin tags) in CD7.57.83−0.937.57.42−1.94
Findings and interventions - Anatomic extent of exam
Ileal intubation? (yes/no)98.750.0098.67−0.22
Rationale for failure to intubate TI if applicable76.5810.0077.17−0.60
Findings and interventions - Findings
Adequate description of degree of endoscopic disease activity in UC using Mayo endoscopy score87.58−0.7177−0.59
Adequate description of degree of endoscopic disease activity in CD using SES-CD7.57.17−0.7176.510.00
Description of the appearance of the terminal ileum88−0.9387.92−0.88
Findings and interventions - Polypoid lesions
Description of morphology and location of raised lesion (diminutive, sessile, pedunculated, flat, laterally spreading)8.38.67−0.2288.17−0.34
Description of whether lesion is in endoscopically colitic or non-colitic mucosa7.57.42−0.7187.580.00
Description of technique of endoscopic removal of polyp/lesion (e.g. biopsy forceps, snare cautery with submucosal lifting, cold snare, jumbo forceps, etc.)76.75−0.71880.00
Crohn's disease with ileo-colonic anastomosis
Maximal distance of neo-terminal ileal insertion (if applicable)87.67−0.717.57.58−0.88
Description of degree of anastomotic and neo-TI inflammation using validated Rutgeerts score87.58−0.715.55.752.35
Segmental description of colonic/rectal inflammation if present87.5−0.7176.67−0.60
Pouchoscopy
Intubation of pre-pouch ileum (yes/no)88.33−0.3488.33−0.34
Description of distribution of pouch inflammation8.58.33−0.3488−0.34
Description of pouch inlet77.67−0.77.57.25−0.71
Description of pre-pouch ileum8.58.25−0.3487.75−0.65
a Table includes a sample selection of only 19 of the 50 included elements. A full list will be presented.

Conclusion

A list of recommended elements for high quality IBD endoscopy reporting stratified by clinical scenario has been described, using a rigorous and evidence-based approach. These can be incorporated into reporting software platforms. Standardized reporting may improve the quality of care in IBD.