Evidence for capsule endoscopy in suspected small bowel Crohn's disease: an evaluation of intergrading system concordance.

BACKGROUND/AIMS: Scientific evidence forms the basis for technology adoption including guideline development and coverage. Evidence is graded using tools including those of US Preventive Services Task Force (USPSTF), American College of Chest Physicians (ACCP), Australian National Health and Medical Research Council (ANHMRC), Oxford Centre for Evidence-Based Medicine (OCEBM), Scottish Intercollegiate Guidelines Network (SIGN). Inter-grading system agreement is generally poor. Application of wireless capsule endoscopy (CE) for evaluation of suspected Crohn's disease (CD) continues to expand in clinical practice with numerous clinical studies reported. METHODS: A systematic literature review was performed examining quality, strength of evidence of CE for suspected CD as well as examination of grading system (guideline) evaluation and inter-grading system variation. Inter-grading system agreement (kappa-statistic) was examined by applying 6 evidence scoring tools to available literature. Because of higher discriminatory power of USPSTF grading system, we further evaluated the 6 most-cited publications against sub-criteria in USPSTF grading system. RESULTS: Inter-grading system agreement rates were higher than anticipated from previous comparisons of 6 methodologies, 0.45-0.65 (95% CI 0.38-0.72). Distinct increase in agreement occurred in highly-cited, newer publications that derived clinical trial designs from older publications. Based upon USPSTF, quality of evidence for use of CE in suspected Crohn's disease was fair to good. CONCLUSIONS: There is adequate evidence based upon accepted, objective grading scores (USPSTF) that CE may be used in the initial evaluation of suspected small bowel Crohn's disease providing confidence to decision makers of the quality and strength of the evidence in guideline development and coverage decisions.