title: Observer agreement in endoscopic assessment of ulcerative colitis.
abstract: BACKGROUND
  Colonoscopy is the investigation of choice to evaluate ulcerative colitis, but the reliability of the assessment of endoscopic signs is not clear.
  
  
  OBJECTIVE
  The aim of this study was to evaluate interobserver agreement for the identification of endoscopic lesions typical of ulcerative colitis, and the influence of training.
  
  
  METHODS
  Four experienced observers and 11 endoscopists under training assessed 49 still images selected from endoscopic video recordings.
  
  
  RESULTS
  The agreement rate between experienced observers was excellent or good (k > 0.39) for recognition of 10 out of 14 signs or patterns (loss of vascular pattern, erythema, oedema, granular mucosa, blood, pseudopolyp, erosion, ulcer, normal pattern, severe activity), and was poor for pus, stricture, mild activity, moderate activity. The rates between endoscopists under training were excellent or good for 6 items (loss of vascular pattern, erythema, oedema, pseudopolyp, normal pattern, severe activity).
  
  
  CONCLUSIONS
  Trained observers can reproducibly record most endoscopic signs of ulcerative colitis. A reliable overall scoring of severity should be based on a simple three-grading scale, i.e. normal pattern, moderate activity, severe activity. Acceptable agreement rates can be obtained by endoscopists under training on some well-defined endoscopic appearances.
authors.affiliation: Department of Gastroenterology, University of Ancona, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Orlandi
authors.forename: E
authors.initials: E
authors.lastname: Brunelli
authors.forename: G
authors.initials: G
authors.lastname: Feliciangeli
authors.forename: G
authors.initials: G
authors.lastname: Svegliati-Baroni
authors.forename: A
authors.initials: A
authors.lastname: Di Sario
authors.forename: A
authors.initials: A
authors.lastname: Benedetti
authors.forename: C
authors.initials: C
authors.lastname: Guidarelli
authors.forename: G
authors.initials: G
authors.lastname: Macarri
mesh_terms: D003093:Colitis, Ulcerative / Q000175:diagnosis*; D003113:Colonoscopy / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity