Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 7, 2017; 23(29): 5371-5378
Published online Aug 7, 2017. doi: 10.3748/wjg.v23.i29.5371
Elaboration and validation of Crohn’s disease anoperineal lesions consensual definitions
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
Clémence Horaist, Department of Digestive Disease, Centre Hospitalier Intercommunal Le Raincy-Montfermeil, 93370 Montfermeil, France
Vincent de Parades, Paul Benfredj, Nadia Fathallah, Department of Proctology, Hôpital Saint-Joseph, Institut Léopold Bellan, 75014 Paris, France
Laurent Abramowitz, Department of Proctology and Digestive Diseases, University Hospital Bichat, AP-HP, 75014 Paris, France
Guillaume Bonnaud, Department of Digestive Diseases, Clinique des Cèdres, 31700 Cornebarrieu, France
Dominique Bouchard, Department of Proctology, Hôpital Bagatelle, 33401 Talence, France
Agnès Sénéjoux, Department of Proctology, Centre Hospitalier Privé Rennes de Saint-Grégoire, 35760 Saint-Grégoire, France
Laurent Siproudhis, Department of Digestive Diseases, Pontchaillou University Hospital, 35000 Rennes, France
Ghislain Staumont, Department of Proctology, Clinique St Jean Languedoc, 31400 Toulouse, France
Manuelle Viguier, AP-HP, Hôpital Saint Louis, Dermatology and Denis Diderot-Paris 7 University, 75013 Paris, France
Philippe Marteau, Sorbonne Universités, UPMC Univ Paris 06, 75005 Paris, France
Philippe Marteau, INSERM-ERL 1157, CHU Saint-Antoine 27, 75012 Paris, France
Philippe Marteau, CNRS, UMR7203, 75012 Paris, France
Philippe Marteau, APHP, Hépatologie et Gastroentérologie, Hôpital Saint Antoine, 75012 Paris, France
Author contributions: Abramowitz L, Benfredj P, Bonnaud G, Bouchard D, Fathallah N, Sénéjoux A, Siproudhis L and Staumont G were in the expert group and contributed to the manuscript; Horaist C, de Parades V and Marteau P performed the literature review, coordinated the expert group, analyzed the data and wrote the draft and final version of the manuscript.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Philippe Marteau, MD, PhD, Professor of Medicine, Hépatologie et Gastroentérologie, Hôpital Saint Antoine, 184 rue du Faubourg Saint Antoine, 75012 Paris, France. philippe.marteau@aphp.fr
Telephone: +331-4928-2382 Fax: +331-4928-3188
Received: December 27, 2016
Peer-review started: December 28, 2016
First decision: Febraury 10, 2017
Revised: May 11, 2017
Accepted: July 4, 2017
Article in press: July 4, 2017
Published online: August 7, 2017
Processing time: 222 Days and 10.4 Hours
Abstract
AIM

To establish consensual definitions of anoperineal lesions of Crohn’s (APLOC) disease and assess interobserver agreement on their diagnosis between experts.

METHODS

A 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.

RESULTS

Terms 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.

CONCLUSION

This study constructed consensual definitions of APLOC and their characteristics and showed that experts have a fair level of interobserver agreement when using most of the definitions.

Keywords: Crohn’s disease; Anoperineal lesions; Fistula; Interobserver agreement

Core tip: We present the first study that establishes consensual definitions of anoperineal lesions of Crohn’s disease (APLOC) and assesses interobserver agreement on their diagnosis. With the help of APLOC experts, we conducted this work using a formal consensus method validated by the French National Authority for Health. We herein establish the missing consensual definitions and show that experts have substantial interobserver agreement when using them to diagnose and describe fistulae, ulcerations, activity of external openings and erythema from photos. Even if inspection is only one step in the diagnoses of APLOC, we believe this work will help future studies evaluate if and how treatments influence these lesions.