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P200 Definitions of the endoscopic lesions in Crohn's disease: reproductibility study and GETAID expert consensus.

A. Buisson*1, 2, J. FILIPPI3, A. Amiot4, G. Cadiot5, M. Allez6, P. Marteau7, Y. Bouhnik8, G. Pineton de Chambrun9, A.-l. Pelletier10, S. Nancey11, D. Moussata11, A. Attar8, A. Blain12, L. Vuitton13, G. Vernier-Massouille14, P. Seksik15, M. Nachury16, J.-L. Dupas17, R. Modigliani6, L. Peyrin-Biroulet18, J.-Y. Mary19, E. Louis20

1University Hospital Estaing, Gastroenterology Department, Clermont-Ferrand, France, 2UMR 1071 Inserm/Université d'Auvergne; USC-INRA 2018, Microbes, Intestine, Inflammation and Susceptibility of the host, Clermont-Ferrand, France, 3Archet 2 University Hospital, Department of Gastroenterology, Nice, France, 4Hospital Henri-Mondor, Department of Gastroenterology, Creteil, France, 5University hospital of Reims, Gastroenterology, Reims, France, 6APHP, Hopital Saint Louis, Department of Gastroenterology, Paris, France, 7Hopital Lariboisiere, Gastroenterologie, Paris, France, 8Beaujon Hospital, Department of Gastroenterology, Clichy la Garenne, France, 9CHU de Montpellier, Department of Gastroenterology, Montpellier, France, 10APHP, Bichat Hospital, Gastroenterology Department, Paris, France, 11Hospices Civils de Lyon, Lyon-Sud hospital, Gastroenterology, Pierre Benite, France, 12APHP-IMM, Gastroenterology Department, Paris, France, 13University hospital of Besançon, Gastroenterology, Besançon, France, 14Tourcoing Hospital, Gastroenterology Department, Tourcoing, France, 15University Hospital of Saint Antoine, APHP, Gastroenterology, Paris, France, 16University hospital of Lille, Gastroenterology, Lille, France, 17Amiens University Hospital, Gastroenterology, Amiens, France, 18CHU Nancy Brabois, Department of Gastroenterology, Vandoeuvre les Nancy, France, 19University Paris VII, Biostatistics Department, Jussieu, France, 20CHU de Liege, Department of Gastroenterology, Liege, Belgium

Background

Emergence of new therapeutic goals in Crohn's disease (CD), such as mucosal healing, has highlighted the need for endoscopic scores. Although other scores are available, the Crohn's Disease Endoscopic Index of Severity (CDEIS) [1] remains, to date, the most validated score to assess the severity of endoscopic lesions in CD. Clarifying the definition of the endoscopic lesions composing this score appeared as a keypoint to optimize the CDEIS use.

Methods

This expert consensus was performed according to the Delphi process to define aphtoid erosions (AE), superficial ulcerations (SU), deep ulcerations (DU), stenosis and fistulas.

 

ECCOJC jju027 P200 F0001

“Delphi process including 12 experts from GETAID”

These definitions were then submitted to 30 independent IBD physicians from the GETAID, to calculate an acceptance rate (AR).

We conducted a reproductibility study assessing the intra and inter-observers agreements to recognize AE, SU or DU during endoscopy using these validated definitions. It was performed from 100 short films (selected by AB) focusing on AE, SU, DU or a sham lesion (25/100 for each lesion).

Overall 15 GETAID members performed this study independently and individually. Among them, 9 did not participate to the definitions step. The intra-observer agreement study was performed one month later with the same 100 films in a randomized order.

 

Results

AE in endoscopy is defined as an ulceration with a white center whose the diameter is less than 5millimetres with red halo (AR=29/30). DU in endoscopy is defined as: a frank depression compared to the surrounding mucosa OR striated bottom of the ulceration OR mucosal detachments OR well-like ulcerations (AR=24/29). A superficial ulceration is defined in endoscopy as: an ulceration whose features fit neither with that of AE nor with that of DU, as previously defined (AR=24/29). A digestive stenosis is defined in endoscopy as a narrowing of the intestinal lumen making impossible or difficult to pass with an adult colonoscope (AR=25/29). A fistula is defined in endoscopy as a deep and well-limited hole whose the bottom cannot be seen, with leaking faecal or purulent material OR with a suspected communication with another organ (AR=27/29). The Results of the reproductibility study will be available at the time of the congress.

Conclusion

The definitions of CD endoscopic lesions retrieved from this GETAID expert panel, if their reproductibility was confirmed, should improve the standardisation and the use of the CDEIS.

References:

[1] Mary JY and Modigliani R., (1989), Development and validation of an endoscopic index of the severity for Crohn's disease: a prospective multicentre study. Groupe d'Etudes Thérapeutiques des Affections Inflammatoires du Tube Digestif (GETAID)., Gut.