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P275 Development and reliability of the new endoscopic virtual chromoendoscopy score: the PICaSSO score (the Paddington International Virtual ChromoendoScopy ScOre) in ulcerative colitis

Iacucci M.*1,2,3, Daperno M.4, Lazarev M.5, Arsenescu R.6, Tontini G.E.7, Lethebe B.C.3, Lowerison M.W.3, Gui X.8, Villanacci V.9, Akinola O.3, Goetz M.10, Vecchi M.7, Neuman H.11, Ghosh S.1, Bisschops R.12, Kiesslich R.13

1University of Birmingham, Institute of Translational Medicine, Birmingham, United Kingdom 2University of Birmingham, UK, United Kingdom 3University of Calgary, Calgary, Canada 4Division of Gastroenterology, Torino, Italy 5Division of Gastroenterology, Baltimore, United States 6Morristown Medical Center, Atlantic Health System, New Jersey, United States 7Division of Gastroenterology IRCCS Policlinico San Donato, Milan, Italy 8University of Calgary, Pathology, Calgary, Canada 9Institute of Pathology ASST Ospedali Civili, Brescia, Italy 10Division of Gastroenterology University Klinikum Tuebingen, Tuebingen, Germany 11Interventional Endoscopy Center, University of Mainz, Mainz, Germany 12Division of Gastroenterology, University Hospitals Leuven, Leuven, Belgium 13Director of Internal Medicine II, HSK Hospital, Wiesbaden, Germany

Background

Endoscopic inflammation and healing are important therapeutic endpoints in ulcerative colitis (UC). We developed and validated a new electronic virtual chromoendoscopy (EVC) score which 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 the three 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 (iscan) by using 20 video clips before (pre-test) and after (post-test) were evaluated. Exploratory univariate factor analysis was performed on “PICaSSO” score covariates for mucosal and vascular score separately. Subsequently a proportional odds logistic regression model for the prediction of histological scores were analysed

Results

The inter-observer agreement for Mayo endoscopic score in the pre-test (k=0.85, 95% CI: 0.78–0.90) and the post test (k=0.85,95% CI: 0.77–0.90) evaluation were very good. This was also true for UCEIS in the pre and post-test score inter-observer agreement (k=0.86,95% CI: 0.77–0.92 and k=0.84, 95% 0.75–0.91). The inter-observer agreement of the PICaSSO endoscopic score was very good in the pre and post-test evaluations (k=0.92, 95% CI: 0.87–96; k=0.89, 95% CI: 0.84–0.94). The accuracy of the overall PICaSSO score in assessing histological abnormalities and inflammation by Harpaz score was 57% (95% CI: 48–65%), by RHI 72% (95% CI: 64–79%) and by ECAP (full spectrum of histologic changes) 83% (95% CI: 76–88%).

Conclusion

The EVC score “PICaSSO” showed very good inter-observer agreement. The new EVC score may be used to define the endoscopic findings of the mucosal and vascular healing in UC and reflected the full spectrum of histological changes.