title: Interobserver Variation Study of the Rutgeerts Score to Assess Endoscopic Recurrence after Surgery for Crohn's Disease.
abstract: BACKGROUND
  After resection surgery for Crohn's disease, recurrence of endoscopic lesions at the site of the anastomosis or in the neoterminal ileum is graded according to the Rutgeerts score (RS). The goal of this study was to test the interobserver variability for RS.
  
  
  METHODS
  Thirteen trained endoscopists evaluated the RS on 39 videotapes of patients who had undergone resection for Crohn's disease with an ileocolonic anastomosis 6 months earlier. Videotapes were randomly assigned to endoscopists through a balanced incomplete block design. Each videotape was scored independently by four endoscopists, and each endoscopist evaluated 12 videotapes, making a total of 156 videotape assessments. Reproducibility levels of the RS were assessed through unweighted kappa estimates among multiple raters. The proportion of inappropriate therapeutic initiation was estimated by randomly selecting one endoscopist for each videorecording, assuming that the majority of endoscopists correctly classified endoscopic recurrence.
  
  
  RESULTS
  The kappa estimates were 0.43 (95% confidence interval: 0.33-0.52) for the RS on a 5-grade scale, 0.47 (0.28-0.66) for RS < i2 vs. ≥ i2, and 0.64 (0.42-0.85) for RS ≤ i2 vs. > i2. The percentages of inappropriate therapeutic initiation were 12.8% (3.8-21.9) when initiation was triggered by a RS ≥ i2 and 8.3% (1.1-15.6) when initiation was triggered by a RS > i2 (p = 0.41).
  
  
  CONCLUSIONS
  The reproducibility of the RS was moderate, especially when differentiating <i2 from ≥i2, which may lead to incorrect therapeutic decisions in >10% of patients.
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris cedex, France Denis Diderot - Paris7 University, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Marteau
authors.affiliation: CHU de Bordeaux, Hôpital Haut-Lévêque, Service d'Hépato-gastroentérologie - Université Bordeaux, Laboratoire de bactériologie, F-33000 Bordeaux, Pessac, France david.laharie@chu-bordeaux.fr.
authors.forename: David
authors.initials: D
authors.lastname: Laharie
authors.affiliation: CHRU de Lille, Hôpital Claude Huriez, Service des Maladies de l'Appareil Digestif -Endoscopie Digestive, Lille, France Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.affiliation: Service d'Hépatogastroentérologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris cedex, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Martin
authors.affiliation: CHRU de Lille, Hôpital Claude Huriez, Service des Maladies de l'Appareil Digestif -Endoscopie Digestive, Lille, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Coevoet
authors.affiliation: Department of Hepatogastroenterology, Hôpital Saint-Louis, Paris, France.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Allez
authors.affiliation: Department of Hepato-Gastroenterology and Digestive Oncology, Hôpital Robert Debré, Boulevard du Général Koenig, 51100 Reims Cedex, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Cadiot
authors.affiliation: CHU de Nantes, Hôtel-Dieu, Hépato-Gastroentérologie, Institut des Maladies de l'Appareil Digestif, F-44093 Nantes, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Bourreille
authors.affiliation: Department of Gastroenterology, Assistance Publique-Hôpitaux de Paris (AP-HP), University Hospitals Paris-Sud, Site de Bicêtre, Paris Sud University, Paris XI, Le Kremlin Bicêtre, Villejuif, France.
authors.forename: Franck
authors.initials: F
authors.lastname: Carbonnel
authors.affiliation: Hôpital Beaujon, Gastroentérologie, Maladies Inflammatoires Chroniques de l'Intestin et Assistance Nutritive, APHP- Université Paris Diderot Paris 7, Clichy, France.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Bouhnik
authors.affiliation: Hôpital Louis Mourier, service d'Hépato-Gastroentérologie, Pôle Maladie Appareil Digestif, APHP - Université Paris VII, F-92700 Colombes, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Coffin
authors.affiliation: Service d'Hépato-Gastroentérologie et Assistance Nutritive, CHU Strasbourg, Strasbourg, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Duclos
authors.affiliation: Service d'Hépato- Gastroentérologie, CHU Amiens, Université de Picardie Jules Verne, Amiens, France.
authors.forename: Jean Louis
authors.initials: JL
authors.lastname: Dupas
authors.affiliation: CHU de Toulouse, Hôpital Rangueil, Service de Gastro-entérologie et Nutrition, F-31059 Toulouse, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Moreau
authors.affiliation: Centre Hospitalier, Universitaire de Liège, Liège, Belgium.
authors.forename: Edouard
authors.initials: E
authors.lastname: Louis
authors.affiliation: Inserm UMR 1153, Equipe Epidemiologie Clinique, Statistique pour la Recherche en Santé, Hôpital Saint-Louis, Université Paris Diderot - Paris 7, Paris, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mary
mesh_terms: D000328:Adult; D000359:Aftercare; D000714:Anastomosis, Surgical; D003082:Colectomy; D003106:Colon / Q000000981:diagnostic imaging* / Q000601:surgery; D003424:Crohn Disease / Q000000981:diagnostic imaging* / Q000601:surgery*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D007082:Ileum / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D015588:Observer Variation; D012008:Recurrence; D015203:Reproducibility of Results; D014741:Video Recording
keywords: Crohn’s disease; Endoscopy; Rutgeerts score; postoperative endoscopic recurrence; reproducibility