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

Table 2 Consensual definitions and agreement scores

Lesions and descriptors	Consensual definitions	Agreement scores1
Ulceration	Skin or mucosal defect	8.7 (8-9]3
Depth
Superficial	Which is not deep	8 (7-9)3
Deep	Visible muscular and/or granulation tissue and/or undermined and inflammatory edges	7.7 (7-9)3
Cavitating	Deep decaying and destructive ulceration	8.6 (8-9)
Localisation
Anal canal	Visible after unfolding the anus radial folds	8.5 (7-9)
Anal margin	Anal external edges	8.5 (7-9)
Perianal	Outside the anus radial folds	9
Extension
Number		8.6 (8-9)
Percentage of ulcerated area	< 25%, 26-50%, > 50% of the anal circumference	8.3 (5-9)
Skin tag	Skin thickening of the anus	7.2 (3-9)
Activity
Inflammatory	Oedematous, swollen, tense	8 (4-9)
Non inflammatory	Fibrous, firm and non-oedematous aspect	8.7 (2-9)
Ulcerated (vs not)	Ulceration on the skin tag (vs no ulceration on the skin tag)	7.8 (2-9)
Perianal skin lesions
Papula	Elevated, circumscribed and solid lesion without liquid content	8.1 (6-9)
Node2	Elevated, nodular and protruding lesion, impression of deep extension	7.8 (6-9)
Oedema	Swollen appearance	8.2 (7-9)
Erythema	Flat redness	8.3 (5-9)
Abscess	Swollen red skin, which may be surrounded by necrosis area and which can release pus	8.3 (7-9)
Fistula
Complexity	AGA’s definitions (3)
	It is possible to recognize that a fistula is complex by inspection alone	7.2 (1-9)
	Inspection alone is not always sufficient to reliably recognize that a fistula is simple	8.5 (7-9)
Drainage
Well drained	Absence of abscess, of purulent discharge an non inflammatory external opening(s)	7.8 (5-9)
Poorly drained	Inflammatory external opening(s) and/or abscess and/or spontaneous purulent discharge	7.5 (5-9)
	Poor drainage of a fistula can be diagnosed by inspection alone	8.6 (7-9)
	Inspection alone is often not sufficient to be certain that a fistula is well drained	7.6 (1-9)
External opening
Inflammatory	Erythematous surrounded skin and budding port(s) with undermined edges	Validated by vote 1
Scar appearance	Deformed anus with fibrous aspect and/or retractile appearance of the anal margin	7.6 (8-9)
	With inflammatory activity or not	7.6 (3-9)

¹Median and distribution;

²Validated by vote 1;

³All definitions obtained a strong agreement except the entity “node”.