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P141 Scoring endoscopy in pediatric inflammatory bowel disease: a way to improve quality

L. Norsa1, A. Ferrari2, S. Arrigo3, M. Bramuzzo4, M. Deganello Saccomani5, G. Di Nardo6, M.T. Illiceto7, E. Miele8, M. Paci9, C. Romano10, E. Romeo11, M. Daperno12, S. oliva13

1ASST Papa Giovanni XXIII, Pediatric Hepatology Gastroenterology and Transplatation, Bergamo, Italy, 2ASST Papa Giovanni XXIII, FROM Research Foundation, Bergamo, Italy, 3G. Gaslini Institute - IRCCS, Gastroenterology- Digestive Endoscopy and Nutrition Unit, Genova, Italy, 4Institute of Child and Maternal Health - IRCCS ‘Burlo Garofolo’, Institute of Child and Maternal Health - IRCCS ‘Burlo Garofolo’, Trieste, Italy, 5This email address is being protected from spambots. You need JavaScript enabled to view it., Pediatric Department, Verona, Italy, 6Sapienza University of Rome- Sant’Andrea University Hospital, Pediatrics- NESMOS Department- School of Medicine and Psychology, Rome, Italy, 7’S. Spirito’ Hospital, Pediatric Gastroenterology and Endoscopy Unit, Pescara, Italy, 8University of Naples ‘Federico II’, Department of Translational Medical Science- Section of Pediatrics, Naples, Italy, 9’Mayer’ Hospital, Pediatric Gastroenterology and Endoscopy Unit, Florence, Italy, 10University of Messina, Pediatric Gastroenterology and Cystic Fibrosis Unit, Messina, Italy, 11Bambino Gesù Children Hospital- IRCCS, Digestive Endoscopy and Surgery Unit, Rome, Italy, 12Mauriziano Hospital Turin, Gastroenterology Unit, Turin, Italy, 13Sapienza – University of Rome, Pediatric Gastroenterology and Liver Unit- Maternal and Child Department, Rome, Italy

Background

The aim of mucosal healing (MH) as a therapeutic target in paediatric inflammatory bowel diseases (IBD) has emphasised the role of the endoscopy. There is a great variability in evaluating mucosal lesions among different operators, especially in paediatric patients. This multicentre prospective study aims to evaluate the interobserver agreement among paediatric endoscopists in using validated endoscopic scores of IBD in children.

Methods

Fifteen videos of follow-up ileocolonoscopies in children with IBD (8 ulcerative colitis –UC-, 7 Crohn’s disease –CD-) were selected from 3 different referral sites in Italy. Eleven paediatric endoscopists from different centres were asked to evaluate all videos as independent and blinded readers. The scoring systems used were ulcerative colitis Endoscopic Index of Severity (UCEIS) for UC and simple endoscopic score for Crohn’s disease (SES-CD) for CD. Kappa statistics and intraclass correlation coefficients were used to measure agreement. Furthermore, an experienced adult gastroenterologist evaluated the same videos and scores them. His results were compared with paediatric endoscopists’ findings.

Results

The median age of the participants was 40 (interquartile range: 6) with a median experience of 12 (14) years in centres with a median number of 140 (230) of paediatric IBDs. Intercluster correlation agreement was 0.298 (95% CI: 0.13–0.55) for UC and 0.266 (0.11–0.52) for CD. When a disease activity categorisation was adopted (remission, moderate, mild and severe) Fleiss’ kappa coefficient was 0.408 (0.29–0.53) for UC and 0.552 (0.43–0.73) for CD (Figure 1). When stratified for item vascular pattern of UC was the most reliable item IC: 0.624 (0.321–0.854). The comparison between paediatric and expert gastroenterologist’s scores is shown in Figure 2. In the multivariate analysis none of the reviewer characteristic affected the readers’ errors.

Conclusion

This pilot multicentre study shows that there is a low level of agreement among paediatric endoscopists in evaluating children with IBDs. Agreement improved after using a disease activity categorisation, with better results for CD. Regardless to experience, all readers showed a low-grade accordance with adult gastroenterologist. According to these findings, the use of scoring systems should be implemented for all paediatric endoscopists. Future specific training programs should be considered to pursue this goal.