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The “DICA” Endoscopic Classification for Diverticular Disease of the Colon Shows a Significant Interobserver Agreement among Community Endoscopists

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Antonio Tursi1, Giovanni Brandimarte2, Francesco di Mario3, Gerardo Nardone4, Carmelo Scarpignato5, Marcello Picchio6, Walter Elisei7, DICA Italian Group (see appendix)

1) Territorial Gastroenterology Service, ASL BAT, Andria, BT
2) Division of Internal Medicine and Gastroenterology, “Cristo Re” Hospital, Rome
3) Division of Gastroenterology, Department of Medicine and Surgery, University of Parma, Parma
4) Division of Gastroenterology, “Federico II” University, Naples
5) Clinical Pharmacology and Digestive Pathophysiology Unit, Department of Clinical and Experimental Medicine, University of Parma, Parma
6) Division of Surgery, “P. Colombo” Hospital, ASL Roma 6, Velletri, Rome
7) Division of astroenterology, ASL Roma
6, Albano Laziale, Rome, Italy

DOI: http://dx.doi.org/10.15403/jgld.2014.1121.281.dic

Background & Aim: An endoscopic classification of Diverticular Disease (DD), called DICA (Diverticular Inflammation and Complication Assessment) is currently available. It scores severity of the disease as DICA 1, DICA 2 and DICA 3. Our aim was to assess the agreement levels for this classification among an endoscopist community setting.
Methods: A total of 66 endoscopists independently scored a set of DD endoscopic videos. The percentages of overall agreement on the DICA score and a free-marginal multirater kappa (κ) coefficient were reported as statistical measures of the inter-rater agreement.
Results: The overall agreement levels were: 70.2% for DICA 1, 70.5% for DICA 2, 81.3% for DICA 3. The free marginal κ was: 0.553 for DICA 1, 0.558 for DICA 2, 0.719 for DICA 3. The agreement levels among the expert group were: 78.8% for DICA 1, 80.2% for DICA 2, 88.5% for DICA 3. The free marginal κ among the expert group were: 0.682 for DICA 1, 0.712 for DICA 2, 0.828 for DICA 3. The agreement of expert raters on the single item of the DICA classification was superior to the agreement of the overall group.
Conclusions: The overall inter-rater agreement for DICA score in this study ranges from moderate to good, with a significant improvement in the expert subgroup of raters. Diverticular Inflammation and Complication Assessment is a simple and reproducible endoscopic scoring system.
Key words: agreement – colonoscopy – diverticular disease of the colon – endoscopic classification.
Abbreviations: CT: computer tomography; DD: diverticular disease; DICA: Diverticula Inflammation and Complications Assessment; SCAD: segmental colitis associated with diverticulosis.