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DOP068 The virtual electronic chromoendoscopy score in ulcerative colitis exhibits very good inter-rater agreement in scoring mucosal and vascular changes after computerised module training: a study across academic and community practice

Trivedi P.*1,2,3,4, Hodson J.3, Bhala N.4, Cooney R.4, Boulton R.4, Gui X.5, Iqbal T.4, Li K.-k.6, Mumtaz S.7, Pathmakanthan S.4, Quraishi M.N.4, Sagar V.M.1, Shah A.7, Sharma N.8, Siau K.7, Smith S.4, Ward S.9, Widlak M.M.10,11, Ghosh S.3,4, Iacucci M.3,4

1University of Birmingham, NIHR Birmingham Liver Biomedical Research Unit, Birmingham, United Kingdom 2Queen Elizabeth Hospital, Liver Unit, Birmingham, United Kingdom 3University of Birmingham, Institute of Translational Medicine, Birmingham, United Kingdom 4Queen Elizabeth Hospital, Department of Gastroenterology, Birmingham, United Kingdom 5University of Calgary and Calgary Laboratory Services, Department of Pathology and Laboratory Medicine, Calgary, Canada 6Leicester Royal Infirmary, Department of Gastroenterology and Hepatology, Leicester, United Kingdom 7New Cross Hospital, Department of Gastroenterology, Wolverhampton, United Kingdom 8University Hospitals Birmingham Heart of England Foundation Trust, Department of Gastroenterology, Birmingham, United Kingdom 9University Hospitals Coventry and Warwickshire, Department of Colorectal Surgery, Coventry, United Kingdom 10University Hospitals Coventry and Warwickshire, Department of Gastroenterology, Coventry, United Kingdom 11University of Warwick, Warwick Medical School, Coventry, United Kingdom

Background

Mucosal healing is the desired therapeutic endpoint for clinical trials in ulcerative colitis (UC). However, conventional white light endoscopy may fall short of capturing the full spectrum of inflammatory change; and virtual electronic chromoendoscopy (VEC) can show ongoing disease activity even when Mayo scores suggest healing (Iacucci et al. Endoscopy 2015). Applicability of VEC scoring requires determination outside the expert setting; thus, our aim was to provide external validation among trainees, consultant gastroenterologists and colorectal surgeons, practicing across six general and specialist centres.

Methods

15 participants reviewed a computerised training module outlining HD and i-Scan modes. Anchor points for the VEC score indicated mucosal changes (crypt distortion, 0 [A–C]; microerosions, I [1–3]; erosions, II [1–3]; and ulceration, III [1–3]) and vascular alterations (non-dilated vessels, 0 [A–C]; dilated/crowded vessels, I [1–3]; mucosal bleeding, II [1–3]; and intraluminal bleeding, III [1–3]). Performance accuracy was tested using a video library pre-/post-training (n=30). Agreement between raters was tested for the Mayo score, UCEIS and VEC score, and results correlated with histology (New York Mount Sinai system; Harpaz et al.).

Results

The inter-rater agreement was very good for the Mayo score, UCEIS scoring erosions/ulcers and overall, and for VEC scoring mucosal patterns in both modules (Table 1). For the vascular components of UCEIS agreement was only moderate, and did not improve post-training; unlike the agreement for VEC vascular patterns which improved significantly to very good. Correlation between histology and VEC score was highly significant for mucosal and vascular scoring (Spearman's ρ: 0.910, p<0.001; and 0.907, p<0.001; respectively, Figure 1). This was superior to the Mayo score (0.876, p<0.001) and UCEIS (0.887, p<0.001).

Table 1. ICCs are from a two-way random model with absolute agreement, and are for single measures. All values are significant at a p<0.001.

Figure 1. Correlation between the EVC score and histology in ulcerative colitis. Average score per video per participant for each category are presented (post-training).

Conclusion

The VEC score demonstrates very good inter-observer agreement across all levels of experience and provides excellent correlation with histology. Unlike UCEIS, the VEC score does not have subjective elements (e.g. mucosal erythema, incidental/contact friability) and may better delineate vascular changes due to filter technology. Given the ability to define subtle endoscopic features, VEC may be applied to further stratify treatment paradigms for patients with UC.