title: Comparison of several activity indices for the evaluation of endoscopic activity in UC: inter- and intraobserver consistency.
abstract: 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.
  
  
  METHODS
  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.
authors: Department of Gastroenterology, Juntendo University School of Medicine, Tokyo, Japan. otaro@juntendo.ac.jp
authors: Taro
authors: T
authors: Osada
authors: Toshifumi
authors: T
authors: Ohkusa
authors: Tetsuji
authors: T
authors: Yokoyama
authors: Tomoyoshi
authors: T
authors: Shibuya
authors: Naoto
authors: N
authors: Sakamoto
authors: Kazuko
authors: K
authors: Beppu
authors: Akihito
authors: A
authors: Nagahara
authors: Michiro
authors: M
authors: Otaka
authors: Tatsuo
authors: T
authors: Ogihara
authors: Sumio
authors: S
authors: Watanabe
mesh_terms: D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000473:pathology; D003106:Colon / Q000473:pathology; D003113:Colonoscopy / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index