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Elaboration and validation of Crohn's disease anoperineal lesions consensual definitions

World Journal of Gastroenterology 2017年第29期23卷 5371-5378页

作者： Clémence Horaist Vincent de Parades Laurent Abramowitz Paul Benfredj Guillaume Bonnaud Dominique Bouchard Nadia Fathallah Agnès Sénéjoux Laurent Siproudhis Ghislain Staumont Manuelle Viguier Philippe Marteau Department of Digestive Disease Centre Hospitalier Intercommunal Le Raincy-Montfermeil Department of Proctology Hopital Saint-Joseph Institut Léopold Bellan Department of Proctology and Digestive Diseases University Hospital Bichat Department of Digestive Diseases Clinique des Cèdres Department of Proctology Hopital Bagatelle Department of Proctology Centre Hospitalier Privé Rennes de Saint-Grégoire Department of Digestive Diseases Pontchaillou University Hospital Department of Proctology Clinique St Jean Languedoc AP-HP H0pital Saint Louis Dermatology and Denis Diderot-Paris 7 University Sorbonne Universités UPMC Univ Paris 06 75005 Paris France INSERM-ERL 1157 CHU Saint-Antoine 27 75012 Paris France CNRS UMR7203 75012 Paris France APHP Hépatologie et Gastroentérologie Hopital Saint Antoine

To establish consensual definitions of anoperineal lesions of Crohn’s (APLOC) disease and assess interobserver agreement on their diagnosis between experts. METHODSA database of digitally recorded pictures of APLOC was examined by a coordinating group who selected two series of 20 pictures illustrating the various aspects of APLOC. A reading group comprised: eight experts from the Société Nationale Française de Colo Proctologie group of study and research in proctology and one academic dermatologist. All members of the coordinating and reading groups participated in dedicated meetings. The coordinating group initially conducted a literature review to analyse verbatim descriptions used to evaluate APLOC. The study included two phases: establishment of consensual definitions using a formal consensus method and later assessment of interobserver agreement on the diagnosis of APLOC using photos of APLOC, a standardised questionnaire and Fleiss’s kappa test or descriptive statistics. RESULTSTerms used in literature to evaluate visible APLOC did not include precise definitions or reference to definitions. Most of the expert reports on the first set of photos agreed with the main diagnosis but their verbatim reporting contained substantial variation. The definitions of ulceration (entity, depth, extension), anal skin tags (entity, inflammatory activity, ulcerated aspect), fistula (complexity, quality of drainage, inflammatory activity of external openings), perianal skin lesions (abscess, papules, edema, erythema) and anoperineal scars were validated. For fistulae, they decided to follow the American Gastroenterology Association’s guidelines definitions. The diagnosis of ulceration (κ = 0.70), fistulae (κ = 0.75), inflammatory activity of external fistula openings (86.6% agreement), abscesses (84.6% agreement) and erythema (100% agreement) achieved a substantial degree of interobserver reproducibility. CONCLUSIONThis study constructed consensual definitions of APLOC and the

关键词： Crohn’s disease anoperineal lesions Fistula Interobserver agreement

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