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首页> 外文期刊>Surgical Endoscopy >Video-laparoscopic assessment of the small bowel in Crohn's disease: a comparative study to evaluate surgeons' inter-observer variability
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Video-laparoscopic assessment of the small bowel in Crohn's disease: a comparative study to evaluate surgeons' inter-observer variability

机译：克罗恩病中小肠的录像腹腔镜评估：评估外科医生的比较研究

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Background Assessment of the entire small bowel is advocated during Crohn's disease (CD) surgery, as intraoperative detection of new lesions may lead to change in the planned procedure. The aim of this study was to evaluate the inter-observer variability in the assessment of extent and severity of CD at the small bowel laparoscopic "walkthrough". Methods A survey on laparoscopic assessment of the small bowel in patients with CD, including items adapted from the MREnterography or ultrasound in Crohn's disease (METRIC) study and from the classification of severity of mesenteric disease was developed by an invited committee of colorectal surgeons. Anonymous laparoscopic videos demonstrating the small bowel "walkthrough" in ileocolonic resection for primary and recurrent CD were distributed to the committee members together with the anonymous survey. The primary outcome was the rate of inter-observer variability on assessment of strictures, dilatations, complications and severity of mesenteric inflammation. Results 12 assessors completed the survey on 8 small bowel walkthrough videos. The evaluation of the small bowel thickening and of the mesenteric fat wrapping were the most reliable assessments with an overall agreement of 87.1% (k = 0.31; 95% CI - 0.22, 0.84) and 82.7% (k = 0.35; 95% CI - 0.04, 0.73), respectively. The presence of strictures and pre-stenotic dilatation demonstrated agreement of 75.2% (k = 0.06: 95% CI - 0.33, 0.45) and 71.2% (k = 0.33; 95% CI 0.15, 0.51), respectively. Evaluation of fistulae had an overall agreement of 75.3%, while there was a significant variation in the evaluation of mild, moderate and severe mesenteric disease with overall agreement ranging from 33.3 to 100%. Conclusion Laparoscopic assessment of the small bowel thickening and of the presence of mesenteric fat wrapping is reliable for the intraoperative evaluation of CD with high inter-rater agreement. There is significant heterogeneity in the assessment of the severity of the mesenteric disease involvement.
机译：背景克罗恩病（CD）手术期间提倡对整个小肠进行评估，因为术中发现新的病变可能会导致计划程序的改变。本研究的目的是评估在小肠腹腔镜“走查”中评估CD程度和严重程度的观察者间差异。方法一个受邀的结直肠外科医生委员会开展了一项关于CD患者小肠腹腔镜评估的调查，包括根据克罗恩病（METRIC）研究中的肠磁共振造影或超声以及肠系膜疾病严重程度分类改编的项目。匿名腹腔镜视频展示了原发性和复发性CD回肠结肠切除术中的小肠“穿行”，与匿名调查一起分发给委员会成员。主要结果是观察者之间评估肠系膜狭窄、扩张、并发症和炎症严重程度的变异率。结果12名评估员完成了对8个小肠走查视频的调查。小肠增厚和肠系膜脂肪包裹的评估是最可靠的评估，总体一致性分别为87.1%（k=0.31；95%CI-0.22,0.84）和82.7%（k=0.35；95%CI-0.04,0.73）。狭窄和狭窄前扩张的存在分别证明了75.2%（k=0.06:95%CI-0.33,0.45）和71.2%（k=0.33；95%CI 0.15,0.51）的一致性。瘘管评估的总体一致性为75.3%，而轻度、中度和重度肠系膜疾病的评估存在显著差异，总体一致性为33.3%至100%。结论腹腔镜评估小肠增厚和肠系膜脂肪包裹是术中评估CD的可靠方法，且具有较高的评分一致性。肠系膜疾病严重程度的评估存在显著的异质性。

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