TY - JOUR
T1 - Standardizing Scoring Conventions for Crohn's Disease Endoscopy
T2 - An International RAND/UCLA Appropriateness Study
AU - Khanna, Reena
AU - Ma, Christopher
AU - Hogan, Malcolm
AU - Zou, Guangyong
AU - Bessissow, Talat
AU - Bressler, Brian
AU - Colombel, Jean Frédéric
AU - Danese, Silvio
AU - Daperno, Marco
AU - East, James E.
AU - Hookey, Lawrence
AU - Loftus, Edward V.
AU - McDonald, John W.D.
AU - Panaccione, Remo
AU - Peyrin-Biroulet, Laurent
AU - Rutter, Matt
AU - Sands, Bruce E.
AU - Vermeire, Séverine
AU - Rémillard, Julie
AU - McFarlane, Stefanie C.
AU - Sandborn, William J.
AU - D'Haens, Geert R.
AU - Feagan, Brian G.
AU - Jairath, Vipul
N1 - Publisher Copyright:
© 2023 AGA Institute
PY - 2023/10
Y1 - 2023/10
N2 - Background and Aims: Endoscopic assessment of disease activity is integral for evaluating treatment response in patients with Crohn's disease (CD). We aimed to define appropriate items for evaluating endoscopic activity and conventions for consistent endoscopic scoring rules in CD. Methods: A 2-round modified RAND/University of California at Los Angeles Appropriateness Method study was conducted. A panel of 15 gastroenterologists used a 9-point Likert scale to rate the appropriateness of statements pertaining to the Simple Endoscopic Score for CD, Crohn's Disease Endoscopic Index of Severity, and additional items relevant to endoscopy scoring in CD. Each statement was voted as appropriate, uncertain, or inappropriate based on the median panel rating and presence of disagreement. Results: Panelists voted that it is appropriate for all ulcers to contribute to endoscopic scoring in CD, including aphthous ulcers, ulcerations at a surgical anastomosis, and anal canal ulcers (scored in the rectum). Endoscopic healing should reflect an absence of ulcers. Narrowing should be defined as a clear decrease in luminal diameter; stenosis should be defined by an impassable narrowing, and if occurring at the junction of 2 segments, scored in the distal segment. Scarring and inflammatory polyps were considered inappropriate for including in the affected area score. The optimal method for defining ulcer depth remains uncertain. Conclusions: We outlined scoring conventions for the Simple Endoscopic Score for CD and Crohn's Disease Endoscopic Index of Severity, noting that both scores have limitations. Therefore, we identified priorities for future research and steps for developing and validating a more representative endoscopic index in CD.
AB - Background and Aims: Endoscopic assessment of disease activity is integral for evaluating treatment response in patients with Crohn's disease (CD). We aimed to define appropriate items for evaluating endoscopic activity and conventions for consistent endoscopic scoring rules in CD. Methods: A 2-round modified RAND/University of California at Los Angeles Appropriateness Method study was conducted. A panel of 15 gastroenterologists used a 9-point Likert scale to rate the appropriateness of statements pertaining to the Simple Endoscopic Score for CD, Crohn's Disease Endoscopic Index of Severity, and additional items relevant to endoscopy scoring in CD. Each statement was voted as appropriate, uncertain, or inappropriate based on the median panel rating and presence of disagreement. Results: Panelists voted that it is appropriate for all ulcers to contribute to endoscopic scoring in CD, including aphthous ulcers, ulcerations at a surgical anastomosis, and anal canal ulcers (scored in the rectum). Endoscopic healing should reflect an absence of ulcers. Narrowing should be defined as a clear decrease in luminal diameter; stenosis should be defined by an impassable narrowing, and if occurring at the junction of 2 segments, scored in the distal segment. Scarring and inflammatory polyps were considered inappropriate for including in the affected area score. The optimal method for defining ulcer depth remains uncertain. Conclusions: We outlined scoring conventions for the Simple Endoscopic Score for CD and Crohn's Disease Endoscopic Index of Severity, noting that both scores have limitations. Therefore, we identified priorities for future research and steps for developing and validating a more representative endoscopic index in CD.
KW - Clinical Trials
KW - Crohn's Disease
KW - Endoscopy
KW - Index
KW - Outcomes
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U2 - 10.1016/j.cgh.2023.05.029
DO - 10.1016/j.cgh.2023.05.029
M3 - Article
C2 - 37308036
AN - SCOPUS:85165976080
SN - 1542-3565
VL - 21
SP - 2938-2950.e6
JO - Clinical Gastroenterology and Hepatology
JF - Clinical Gastroenterology and Hepatology
IS - 11
ER -