Original Article
Image documentation of endoscopic findings in ulcerative colitis: photographs or video clips?

https://doi.org/10.1016/S0016-5107(05)00337-8Get rights and content

Background

Previous studies have shown deficiencies in the endoscopy reports and substantial interobserver variation in the assessments of endoscopic findings. The aim of this study was to determine how to perform systematic digital image documentation in ulcerative colitis and to evaluate if mucosal inflammation is assessed equally on a still image and on a video clip.

Methods

Eighteen video clips and their corresponding photographs that visualize different severities of ulcerative colitis were shown in randomized order to 20 experienced endoscopists. They assessed the mucosal inflammation of each image twice on a visual analog scale. Three comparisons were performed between the video clips, the photographs, and the video clips to the photographs, respectively.

Results

The mean score of the inflammation of the video clips at tape 1 and 2 was 4.74: 95% confidence interval (CI)[4.41, 5.08] and 4.90: 95% CI[4.56, 5.24), respectively, and of the photographs 4.53: 95% CI[4.19, 4.88] and 4.43: 95% CI[4.09, 4.77], respectively. The first answer explains 83% of the variation in the second answer for all comparisons, and the agreement index ranged from 0.38 to 0.42.

Conclusions

The mucosal inflammation might be documented nearly as well with a still image as on a video clip. Systematic use of still images probably improves the endoscopy reports by adding more objective information about the mucosal inflammation.

Section snippets

Patients and methods

The study was approved by the local ethic committee and performed according to the Helsinki Declaration. The study enrolled 4 patients admitted for a scheduled colonoscopy. They had various degrees of UC. Three of the patients received medication with 20 mg Buscopan IV (hyoscine butylbromide; Boehringer Ingelheim, International GmbH, Ingelheim am rhein, Germany) to optimize the visibility. The retraction of the colonoscope from the cecum was digitally recorded on a Sony digital video (DV) CAM

Comparisons of the mean score of inflammation

There was no significant difference in the mean score of inflammation between P1 and P2. However, there was a slight, though statistically significant, difference between V1 and V2 and between V1 and P2. The mean score of inflammation was 5% to 10% lower when using the photographs (Table 1).

Repeatability of assessments between two sessions

The scatter diagrams in Figure 2 appear to show identical patterns in the comparisons V1 to V2 (Fig. 2A), P1 to P2 (Fig. 2B), and V1 to P2 (Fig. 2C), respectively. In all 3 regression models relating two

Discussion

The present study clarifies a major concern and determines the role of still images compared with video clips in systematic image documentation. It clearly demonstrates that the mucosal inflammation in ulcerative colitis might be assessed nearly as well with still images as with video clips with both an identical repeatability between the observations and a good intraobserver agreement. However, when graded on a VAS, the inflammation was scored slightly lower on the photographs. Nevertheless,

Acknowledgments

We thank the 20 observers; E. Aadland, Z. Konopski, O. C. Lunde (Aker University Hospital); J. Løvik, A. Rydning, T. Sandanger, J. Skötö (Akershus University Hospital); E. Lind, Ø. Dyrhaug, H. Torvik (Asker and Bærum Central Hospital); V. Skar, F. Strøm, R. Tronstad (Lovisenberg Diakonale Hospital); F. Lerang, T. Hauge, B. Moum, P. Sandvei (Østfold Central Hospital), B. Hofstad, I. Lygren, C. Solberg (Ullevål University Hospital).

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    This work was a poster at Digestive Disease Week, May 15-20, 2004, New Orleans, Louisiana (Gastrointest Endosc 2004;59:AB272).

    Oral presentation at the Nordic meeting of Gastroenterology, June 2-5, 2004, Oslo, Norway (Scand J Gastroenterol 2004;39[Suppl 240]:34).

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    Copyright © 2005 American Society for Gastrointestinal Endoscopy. Published by Mosby, Inc. All rights reserved.