Background:
This study evaluated inter- and intraobserver agreement in the assessment of ulcerative colitis (uc) activity using 4 established indices and a newly designed modified 6-point activity index.
Method:
In all, 279 endoscopic pictures of inflammatory lesions from 93 uc patients were displayed twice to 4 expert and 4 trainee endoscopists, at an interval of 1 month. each picture was assessed for inflammatory changes using established indices (matts, schroeder [a.k.a. mayo score], baron, and blackstone) and our new modified 6-point activity index. weighted kappa statistics were used to estimate intra- and interobserver variation.
Results:
The matts and schroeder indices gave a "good" degree of concordance for expert endoscopists in terms of inter- and intraobserver agreements (0.74-0.78); this was not so evident with the baron and blackstone indices (0.61-0.73). for trainee endoscopists, all scores for inter- and intraobserver weighted kappa values using established indices (0.41-0.51) were lower than for the experts. the degree of concordance using the modified 6-point activity index was rated as "good" for inter- and intraobserver agreements for expert endoscopists (0.65 and 0.79), and as "moderate" for trainee endoscopists (0.54 and 0.64).
Conclusions:
Accurate assessment of uc disease activity from endoscopic findings benefited from experience. for expert endoscopists, the matts and schroeder indices proved the most reliable of the 4 established indices. current endoscopic technologies may be adequate for assessing uc activity, particularly if modified to permit a finer classification of disease severity based on 6 grades, as with our newly developed modified 6-point activity index.