Year 2025 / Volume 117 / Number 9
Original
Interobserver variability of endoscopic scores and their subsections in Crohn’s disease — A single-center prospective study

506-512

DOI: 10.17235/reed.2025.10923/2024

Laura Lorenzo González, Daniel Barranco Castro, Victoria Alejandra Jiménez García, Teresa Romero García, Rocío Ferreiro Iglesias, Isabel Vera Mendoza, Blas José Rodríguez Gómez, Manuel Rodríguez-Téllez, Cloé Charpentier, Federico Argüelles-Arias,

Abstract
Background and aims: accurate endoscopic assessment is crucial for treatment decisions in Crohn’s disease (CD), but endoscopic scores are complex and not easily applicable in routine practice. This study aimed to assess interobserver reproducibility of Crohn’s Disease Endoscopic Index of Severity (CDEIS), Simple Endoscopic Score for Crohn’s Disease (SES-CD) and their subsections, in inflammatory bowel disease (IBD) experts and non-experts, to improve endoscopic assessment. Methods: an observational, prospective study was performed including 22 CD patients who underwent routine colonoscopy at an IBD unit, after excluding patients with inadequate bowel preparation (Boston Bowel Preparation score < 6). Seven endoscopists from four centers, four specialized in IBD, independently scored the videos using CDEIS and SES-CD. Interobserver variability was assessed, comparing IBD experts and non-experts, and correlating endoscopic scores with clinical activity and biomarkers. Results: overall intra-class correlation coefficient (ICC) was 0.83 for CDEIS and 0.77 for SES-CD, indicating substantial agreement. The lowest correlations were found with deep ulcers in the ileum, descending colon, and rectum (CDEIS), and ulcer size in the ileum and stricture detection in the descending colon (SES-CD). Non-IBD experts showed higher interobserver agreement (ICC: 0.91 CDEIS, 0.88 SES-CD) compared to IBD experts (ICC: 0.79 for both). No correlation was found between endoscopic scores and Harvey-Bradshaw index or C-reactive protein (CRP). SES-CD showed a significant correlation with fecal calprotectin (0.58, p = 0.01) and CDEIS trended towards significance (r = 0.44, p = 0.064). Regarding endoscopic remission, 22 % patients were inconsistently classified. Conclusions: although CDEIS and SES-CD are highly reproducible without specialized training, they have limitations to detect mild inflammatory activity. An ideal score should emphasize ileal activity and simplify the assessment of ulceration severity and stenosis to improve clinical utility.
Lay Summary
Crohn’s disease is a long-term condition that causes inflammation within the digestive tract. To guide treatment, doctors often use colonoscopy to examine the bowel and score the level of inflammation. However, the scoring systems used can be complex and hard to apply in everyday practice. This study looked at how consistently different doctors use two common scoring systems when reviewing colonoscopy videos. We included 22 people with Crohn’s disease who had routine colonoscopies. Seven doctors from four hospitals—some with special training in digestive diseases and some without—independently scored the videos. We found that both scoring systems gave fairly consistent results between doctors, even for those without specialist training. However, there was less agreement when scoring deep ulcers and areas where the bowel was narrowed, especially in certain regions like the lower small intestine and the rectum. Interestingly, non-specialist doctors had slightly better agreement than the specialists. The scores did not always match the patient’s symptoms or common blood tests. However, a stool test used to measure gut inflammation (called fecal calprotectin) showed a moderate connection with the scores. In about one out of five patients, doctors disagreed on whether the disease was inactive. These findings suggest that a simpler and more focused scoring system—especially one that better assesses the lower small intestine and makes it easier to judge ulcer severity and narrowing—could improve how Crohn’s disease is monitored in clinical practice.
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Citation tools
Lorenzo González L, Barranco Castro D, Jiménez García V, Romero García T, Ferreiro Iglesias R, Vera Mendoza I, et all. Interobserver variability of endoscopic scores and their subsections in Crohn’s disease — A single-center prospective study. 10923/2024


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Publication history

Received: 05/11/2024

Accepted: 12/05/2025

Online First: 12/06/2025

Published: 15/09/2025

Article revision time: 109 days

Article Online First time: 219 days

Article editing time: 314 days


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