Concordância entre o escore endoscópico de Mayo e o Índice Endoscópico de Gravidade da Colite Ulcerativa (UCEIS) na avaliação da atividade endoscópica na retocolite ulcerativa
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2023-08-01
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Universidade Estadual Paulista (Unesp)
Resumo
A Retocolite Ulcerativa (RCU) é uma doença inflamatória crônica do cólon e reto, acometendo estes segmentos continuamente da porção distal para proximal. Varia em extensão e intensidade da inflamação, causando importante impacto na qualidade de vida, além de complicações graves. A colonoscopia é fundamental no diagnóstico e orientação terapêutica a ser adotada. A escolha dos medicamentos e até mesmo a necessidade de abordagem cirúrgica dependem de diversos fatores, que englobam aspectos clínicos, laboratoriais, endoscópicos e histológicos. A avaliação endoscópica da RCU é realizada de forma bastante difundida utilizando-se o Escore Endoscópico da Clínica Mayo. Porém, apesar de bem estabelecida entre os especialistas, este escore apresenta um caráter demasiadamente subjetivo, apresenta limitações tais como a falta de validação, a incapacidade de distinção entre úlceras superficiais e profundas e a classificação baseada no segmento do cólon com doença em atividade mais intensa, o que provoca considerável discordância entre examinadores na classificação da gravidade da doença. Com o objetivo de reduzir a subjetividade do escore de Mayo, foi desenvolvida um escore que contempla de forma mais objetiva os parâmetros observados à colonoscopia, o Índice Endoscópico de Gravidade da Colite Ulcerativa (Ulcerative Colitis Endoscopic Index of Severety - UCEIS).
OBJETIVOS: Verificar se há relação entre a gravidade endoscópica encontrada nos escores de Mayo e UCEIS. Verificar se há concordância entre examinadores diferentes em relação à classificação endoscópica no escore de Mayo e UCEIS. Relacionar os achados endoscópicos e suas respectivas classificações no escore de Mayo e UCEIS a parâmetros clínicos como idade, sexo, raça e extensão do acometimento pela doença.
MATERIAIS E MÉTODOS: O trabalho foi realizado com os pacientes portadores de RCU atendidos no ambulatório de DII do HC-UNESP. Os pacientes foram submetidos à colonoscopia, que foi gravada em forma de vídeo e avaliada por três examinadores diferentes. Cada examinador classificou os achados endoscópicos conforme os escores de Mayo e UCEIS. As classificações e gravidade encontradas por cada examinador foram comparadas entre cada escore e entre os examinadores. Foi também realizado um levantamento do perfil dos pacientes atendidos no ambulatório (idade, sexo, raça e extensão de acometimento pela RCU), que foi relacionado à gravidade endoscópica encontrada nas suas respectivas colonoscopias.
RESULTADOS: Foi observada uma relação significativa entre os índices de gravidade encontrados no escore de Mayo e no UCEIS quando comparadas pelo mesmo observador. Assim como houve também correlação significativa entre os escores encontrados pelos três observadores tanto no escore de Mayo quanto no UCEIS, com ligeira superioridade neste último.
CONCLUSÃO: A colonoscopia é um procedimento fundamental na avaliação da RCU. O exame realizado por profissionais capacitados e experientes na avaliação desta enfermidade traz informações muito importantes para o seguimento do paciente, e com alto grau de confiabilidade quando usados escores com termos descritivos e classificação de gravidade bem estabelecidos. O escore UCEIS mostrou-se superior ao de Mayo em relação ao grau de concordância entre os observadores. O cruzamento de informações sobre o perfil de cada paciente e da gravidade endoscópica da sua doença auxilia na oferta de um tratamento otimizado e individualizado visando a remissão da RCU.
Ulcerative colitis (UC) is a chronic inflammatory disease of the colon and rectum, continuously affecting these segments from the distal to the proximal portion. It varies in extent and intensity of inflammation, causing a significant impact on quality of life, in addition to serious complications. Colonoscopy is fundamental in the diagnosis and therapeutic orientation to be adopted. The choice of drugs and even the need for a surgical approach depend on several factors, which include clinical, laboratory, endoscopic and histological aspects. Endoscopic evaluation of UC is performed in a very widespread way using the endoscopic component of the Mayo Clinic Clinical Score (MCS). However, despite being well established among specialists, this scale is too subjective, which causes considerable disagreement between examiners in classifying the severity of the disease. With the aim of reducing the subjectivity of the Mayo scale, a scale was developed that more objectively contemplates the parameters observed at colonoscopy, the Ulcerative Colitis Endoscopic Index of Severity - UCEIS. OBJECTIVES: To verify whether there is a relationship between the endoscopic severity found in the Mayo and UCEIS scores. Check if there is agreement between different examiners regarding the endoscopic classification in the MCS and UCEIS. Relate the endoscopic findings and their respective classifications in the MCS and UCEIS to clinical parameters such as gender, age, race and extent of disease involvement. MATERIALS AND METHODS: The work was carried out with patients with UC treated at the IBD clinic at HC-UNESP. The patients underwent colonoscopy, which was recorded on video and evaluated by three different examiners. Each examiner classified the endoscopy findings according to the Mayo and UCEIS scales. The ratings and severity found by each examiner were compared between each scale and between examiners. A suvey was also carried out on the profile of patients treated at the outpatient clinic (age, sex, race and extent of involvement by UC), which was related to the endoscopic severity found in their respective colonosco-pies. RESULTS: A significant relationship was observed between the severity indices found on the Mayo scale and on the UCEIS described by the same observer. Just as there was also a significant correlation between the scores found by the three observers both in the MCS and in the UCEIS, with a slight superiority in the latter. CONCLUSION: Colonoscopy is a fundamental procedure in the evaluation of UC. The examination carried out by trained and experienced professionals in the evalu-ation of this disease provides very important information for patient follow-up, and with a high dgree of reliability when using scores with descriptive terms and a well-established sevity scale. The UCEIS scale was superior to the Mayo scale in rela-tion to the degree of agreement between observers. The crossing of information about the profile of each patient and the endscopic sverity of their disease helps to offer an optimized and individualized treatment aimed at the remission of UC.
Ulcerative colitis (UC) is a chronic inflammatory disease of the colon and rectum, continuously affecting these segments from the distal to the proximal portion. It varies in extent and intensity of inflammation, causing a significant impact on quality of life, in addition to serious complications. Colonoscopy is fundamental in the diagnosis and therapeutic orientation to be adopted. The choice of drugs and even the need for a surgical approach depend on several factors, which include clinical, laboratory, endoscopic and histological aspects. Endoscopic evaluation of UC is performed in a very widespread way using the endoscopic component of the Mayo Clinic Clinical Score (MCS). However, despite being well established among specialists, this scale is too subjective, which causes considerable disagreement between examiners in classifying the severity of the disease. With the aim of reducing the subjectivity of the Mayo scale, a scale was developed that more objectively contemplates the parameters observed at colonoscopy, the Ulcerative Colitis Endoscopic Index of Severity - UCEIS. OBJECTIVES: To verify whether there is a relationship between the endoscopic severity found in the Mayo and UCEIS scores. Check if there is agreement between different examiners regarding the endoscopic classification in the MCS and UCEIS. Relate the endoscopic findings and their respective classifications in the MCS and UCEIS to clinical parameters such as gender, age, race and extent of disease involvement. MATERIALS AND METHODS: The work was carried out with patients with UC treated at the IBD clinic at HC-UNESP. The patients underwent colonoscopy, which was recorded on video and evaluated by three different examiners. Each examiner classified the endoscopy findings according to the Mayo and UCEIS scales. The ratings and severity found by each examiner were compared between each scale and between examiners. A suvey was also carried out on the profile of patients treated at the outpatient clinic (age, sex, race and extent of involvement by UC), which was related to the endoscopic severity found in their respective colonosco-pies. RESULTS: A significant relationship was observed between the severity indices found on the Mayo scale and on the UCEIS described by the same observer. Just as there was also a significant correlation between the scores found by the three observers both in the MCS and in the UCEIS, with a slight superiority in the latter. CONCLUSION: Colonoscopy is a fundamental procedure in the evaluation of UC. The examination carried out by trained and experienced professionals in the evalu-ation of this disease provides very important information for patient follow-up, and with a high dgree of reliability when using scores with descriptive terms and a well-established sevity scale. The UCEIS scale was superior to the Mayo scale in rela-tion to the degree of agreement between observers. The crossing of information about the profile of each patient and the endscopic sverity of their disease helps to offer an optimized and individualized treatment aimed at the remission of UC.
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Palavras-chave
Colite ulcerativa, Colonoscopia, Mayo, UCEIS