ORIGINAL ARTICLE

Recommendations for Quality Colonoscopy Reporting for Patients

with Inflammatory Bowel Disease: Results from a RAND
Appropriateness Panel
Shane M. Devlin, MD,* Gil Y. Melmed, MD, MS,† Peter M. Irving, MA, MD,‡ David T. Rubin, MD,§
Asher Kornbluth, MD,k Patricia L. Kozuch, MD,¶ Laura E. Raffals, MD, MS,**
Fernando S. Velayos, MD, MPH,†† Miles P. Sparrow, MB, BS,‡‡ Leonard Baidoo, MD,§§
Brian Bressler, MD, MS,kk Adam S. Cheifetz, MD,¶¶ Jennifer Jones, MD, MSc,*** Gilaad G. Kaplan, MD, MPH,*
and Corey A. Siegel, MD, MS†††

Background: Consensus on what constitutes a quality colonoscopy report for patients with inflammatory bowel disease (IBD) is lacking. We
developed a template for quality colonoscopy reporting that can be used broadly by endoscopists.
Methods: After a literature review of topics relevant to colonoscopy reporting, members of the Building Research in Inflammatory Bowel Disease
Globally (BRIDGe) group and 2 external experts proposed candidate reporting elements. The RAND/University of California, Los Angeles
appropriateness method was applied to rate the importance and feasibility of elements for inclusion in colonoscopy reports for patients with IBD.
Panelists used the modified Delphi method to anonymously rate the importance and feasibility of candidate elements on a 1-to-9 scale (1–3: not important/
feasible, 4–6: moderately important/feasible, 7–9: very important/feasible). Disagreement was assessed using a validated index. The panelists then met in
person for discussion followed by a second round of voting. Elements rated a median of 7 or higher on importance after rerating were retained.
Results: One hundred two reporting elements were proposed. A total of 48 elements were retained across the four themes of “disease background,”
“findings and interventions,” “Crohn’s disease with an ileocolonic anastomosis,” and “pouchoscopy.”
Conclusions: A comprehensive list of recommended elements for quality IBD colonoscopy reporting stratified by clinical scenario has been described,
using a rigorous and evidence-based approach. These elements can be incorporated into endoscopy reporting software platforms. Standardized
endoscopy reporting may improve the quality of care in IBD.
(Inflamm Bowel Dis 2016;22:1418–1424)
Key Words: quality, colonoscopy, ulcerative colitis, Crohn’s disease, inflammatory bowel disease

C olonoscopy is an important tool for practitioners who treat

patients with gastrointestinal disorders. However, varia-
tion in the quality of the procedure and its reporting is a common
clinical problem that has led to studies addressing the adequacy
of training and reporting of endoscopic procedures.1,2 Most of
this literature, however, pertains to colonoscopy in general and
in particular to colonoscopy as a tool for colorectal cancer
screening. Although the quality of a colonoscopy is equally
relevant in the context of all indications for the procedure,
there is little literature pertaining to specific quality elements

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on
the journal’s Web site (www.ibdjournal.org).
Received for publication November 24, 2015; Accepted January 28, 2016.
From the *The University of Calgary, Calgary, Alberta, Canada; †Cedars-Sinai Medical Center, Los Angeles, California; ‡Inflammatory Bowel Disease Centre, Guy’s and St.
Thomas’ Hospitals, London, United Kingdom; §Department of Medicine, Inflammatory Bowel Disease Center, The University of Chicago, Chicago, Illinois; kDr. Henry D.
Janowitz Division of Gastroenterology, Mount Sinai School of Medicine, New York, New York; ¶Jefferson University, Philadelphia, Pennsylvania; **Mayo Clinic, Rochester,
MN; ††University of California San Francisco, San Francisco, California; ‡‡Department of Gastroenterology, The Alfred Hospital, Melbourne, Australia; §§University of
Pittsburgh, Pittsburgh, Pennsylvania; kkUniversity of British Columbia, Vancouver, British Columbia, Canada; ¶¶Beth Israel Deaconess Medical Center, Harvard Medical
School, Boston, Massachusetts; ***Dalhousie University, Halifax, Nova Scotia, Canada; and †††Inflammatory Bowel Disease Centre, Dartmouth-Hitchcock Medical Center,
Lebanon, New Hampshire.
The in-person RAND panel meeting was funded by educational grants from AbbVie, Janssen, Salix, and UCB.
The authors have no conflict of interest to disclose relevant to the content of this manuscript.
Reprints: Shane M. Devlin, MD, 1031 Russet Road NE, Calgary, AB T2E5L2, Canada (e-mail: devlins@ucalgary.ca).
Copyright © 2016 Crohn’s & Colitis Foundation of America, Inc.
DOI 10.1097/MIB.0000000000000764
Published online 8 April 2016.

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Copyright © 2016 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.
Inflamm Bowel Dis  Volume 22, Number 6, June 2016
relevant to particular disease states such as inflammatory bowel
disease (IBD).
Several societies have developed guidelines around quality
indicators for colonoscopy and endoscopy that focus primarily on
the technical elements of the procedure and procedural safety.3–6
The American College of Gastroenterology (ACG) and the Amer-
ican Society for Gastrointestinal Endoscopy (ASGE) have
recently published updated guidelines around quality indicators
for colonoscopy.7,8
The ASGE has proposed guidelines in terms of quality
colonoscopy reporting, although adherence to these guidelines is
variable.9,10 There are 19 recommended elements spanning all
aspects of the procedure, which are meant to be general and
inclusive of all colonoscopies for any indication.9 A description
of the findings is among the recommended elements, but guidance
on how to describe findings in IBD is lacking.
The Canadian Association of Gastroenterology (CAG) has
outlined 23 consensus statements that describe recommended
guidelines around a variety of elements of the procedure and
periprocedural components from both a practitioner-centered and
patient-centered approach.11 The CAG guidelines have focused
increasingly on disease-specific findings and recommend that endo-
scopic reports be completed in a standardized electronic format
including mandatory fields with standardized descriptions and vali-
dated scales of disease activity such as the Mayo score for ulcerative
colitis (UC) and the simple endoscopic score for Crohn’s disease
(SES-CD).11–13 Indeed, systematized reporting has been found to
provide more consistent reporting of degrees of inflammation in
UC in one of the few studies evaluating the quality of endoscopic
reporting in IBD.14 However, even the CAG guidelines fail to address
the totality of a colonoscopy performed in a patient with IBD.
Unique phenotypic and anatomical considerations for IBD
are recognized; however, none are well considered in existing
quality guidelines. Furthermore, because the endoscopic appear-
ance of the mucosa is critical to therapeutic decision-making,
variation in the quality of a report can lead to either a less-precise
understanding of current disease activity or the need for a repeat
procedure in the setting of a second opinion or transfer of care.
Given the complexity and potential variability of colono-
scopy reporting in IBD, we aimed to identify elements that should
be included in a quality colonoscopy report for a patient with IBD.
As such, the Building Research in Inflammatory Bowel Disease
Globally (BRIDGe) group sought to develop a Quality Template
for IBD Endoscopy Reporting (UMPIRE).
METHODS
Study Overview
The RAND/University of California, Los Angeles appro-
priateness method is a widely used, iterative, evidence-based
process that combines the best available evidence with the expert
opinion of the available literature to determine the appropriateness
of processes of care in medicine.15
Copyright © 2016 Crohn’s & Colitis Foundation of America, Inc. Unauthorized reproduction of this article is prohibited.
Recommendations for Quality Colonoscopy Reporting
Literature Review
We conducted a nonsystematic literature search in Septem-
ber 2012 to identify articles relevant to quality indicators for
colonoscopy, polypoid lesions in IBD, dysplasia surveillance,
endoscopic disease activity indices in IBD, and endoscopy of the
ileoanal pouch. As there is a paucity of literature on quality
reporting specifically, this nonsystematic review was intended to
provide context and guide discussion. A summary document was
prepared and distributed to all panelists for review before the first
round of ratings.
Proposed Elements for Inclusion in
a Colonoscopy Report
The focus of the panel was to identify specific elements of
colonoscopy reporting for commonly performed procedures for
patients with IBD. Out of scope areas of quality improvement that
we did not address included the quality of the endoscopy unit, the
credentials of the endoscopist, the quality of the bowel prepara-
tion, or the requirement to obtain photodocumentation of relevant
findings and landmarks or other elements described in these
guidelines. These are well reported in existing guidelines.
Three authors (S.M.D., C.A.S., G.Y.M.) proposed a total of
102 candidate reporting elements in the following categories:
“disease background,” “findings,” “dysplasia surveillance,” “CD
with an ileocolonic anastomosis,” “CD with a colo-colonic anas-
tomosis,” and “pouchoscopy.”
Appropriateness Panel
The panel consisted of 13 members of the BRIDGe group,
composed of gastroenterologists engaged in IBD research (www.
BRIDGeIBD.com) including members from the United States,
Canada, Australia, and the United Kingdom as previously
described.16 In addition, 2 content experts identified through their
publication record on the topic of clinical care in IBD (DR and
AK) were consulted (DR provided input and voted as a panelist,
whereas AK provided input but did not participate in actual vot-
ing). After receiving the literature summary, panelists confiden-
tially rated the proposed elements for importance and feasibility
on a 1-to-9 scale (1–3: not important/feasible, 4–6: moderately
important/feasible, 7–9: very important/feasible). Disagreement
was associated using a validated RAND/UCLA disagreement
index as previously described.17 Panelists convened 2 weeks later
at a moderated in-person meeting. During this meeting, highly
rated and controversial elements were discussed in detail, after
which panelists confidentially rerated each proposed element.
Analysis
Median scores of both feasibility and importance were
calculated. Scores achieving a median of 7 or more on importance
after final revoting were included in the final set. Data on feasibility
were collected but were not criteria for inclusion in the final set. It
was believed that the feasibility of reporting certain elements might
vary based on the type of reporting software being used.
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Devlin et al Inflamm Bowel Dis  Volume 22, Number 6, June 2016

RESULTS the procedure, and impressions and recommendations arising from

Overall Results
A total of 68 reporting elements were retained on the basis of
importance, across 4 domains: 1. disease background, 2. findings and
interventions, 3. CD with an ileocolonic anastomosis, 4. poucho-
scopy. Of these, 20 reporting elements were duplicated in 2 or more
domains and redundant elements were excluded; thus, a total of 48
reporting elements were retained in the final set (Tables 1–4). Drop-
down menus are included with each table to describe how certain
elements could be incorporated into endoscopy reporting software
platforms. Disagreement was noted on 9 elements, of which 2 were
included in the final set. Elements that were rated less than 7 and thus
excluded from the final set can be found in supplementary Table 1
(Supplemental Digital Content 1, http://links.lww.com/IBD/B248).
Disease Background
Four reporting elements were included in the final set
pertaining to disease background including disease phenotype,
indication for the procedure, IBD therapy, and symptoms at the
time of the procedure (Table 1). These were deemed important to
include in any colonoscopy report for all patients with IBD. Of
note, when describing the IBD disease phenotype, panelists
favored a general description over the more formal alphanumeric
Montreal classification (Table 1).18 The indication for the proce-
dure could be generalized into one of 3 categories: (1) disease
activity assessment, (2) dysplasia surveillance, and (3) assessment
of therapeutic response to treatment. There was no disagreement
noted in this domain. Inclusion of the specific IBD therapy at the
time of the procedure met criteria for importance but was deemed
to be potentially less feasible (Table 1).
Findings and Interventions
Nineteen reporting elements were included in the final set
that related to endoscopic findings, interventions undertaken during
the procedure (Table 2). In the initial round of rating, panelists
could choose between describing the endoscopic disease activity
of the mucosa using general descriptors or by using established
scoring indices (SES-CD and Mayo score for UC). Initially, the
panelists preferred general descriptors. However, after numerous
attempts to determine descriptive terms to use in UC and CD, the
panelists revoted and elected to advocate for the use of the SES-CD
and Mayo score as all descriptive terms proposed by the panelists
mirrored those of the established indices. However, the panelists
believed that the value of the established indices was the descriptive
terminology and that their respective quantitative aspect need not
be incorporated routinely into reports. There was disagreement on
the importance of one element (rationale for failure to intubate the
terminal ileum if applicable). All included elements in findings and
interventions were deemed feasible.
CD with an Ileocolonic Anastomosis
Eight reporting elements were included in the final set that
related to colonoscopy in the patient with an ileocolonic anastomosis
(Table 3). Panelists believed that the endoscopist could describe
inflammation associated with the ileocolonic anastomosis and neo-
terminal ileum using either the Rutgeerts score or any general de-
scriptors of inflammation that described the presence and nature of
ulceration and the presence or absence of any stricturing (Table 3).19
Proposed reporting elements ultimately mirrored those of the
Rutgeerts score, hence the inclusion of either approach. There was
no disagreement regarding the importance of any included elements,
but the use of the Rutgeerts score was deemed to be less feasible.
Pouchoscopy
Seventeen reporting elements were included in the final set
that related to the performance of a pouchoscopy in a patient with an
ileal pouch–anal anastomosis (Table 4). These reporting elements
included disease background, description of perianal findings,

TABLE 1. Disease Background Elements Relevant to All IBD Colonoscopies

Reporting Elements Importance Rating Feasibility Rating

Disease background elements for all IBD procedures

General description of disease type and extenta Med: 7; DI: 20.60 Med: 7; DI: 20.71
Specific indication for procedureb Med: 9; DI: 0.0 Med: 9; DI: 20.22
Specific IBD therapy at the time of procedurec Med: 7; DI: 23.08 Med: 6.5; DI: 2.72
Description of symptoms at the time of current evaluationd Med: 7; DI: 20.71 Med: 7; DI: 20.71

a
Drop-down menu would include relevant descriptors, and the endoscopist can select all those that apply. For CD: upper gastrointestinal tract disease, jejunal disease, ileal disease,
colonic disease, perianal disease, penetrating disease, stricturing disease. For UC: pancolitis, left-sided UC, proctitis.
b
Drop-down menu would include disease activity assessment and assess therapeutic response to therapy, dysplasia surveillance.
c
Drop-down menu would include relevant medications, and the endoscopist can select all those that apply: prednisone, budesonide, mesalamine, antibiotics, tacrolimus, cyclosporine,
azathiopurine/6-mercaptopurine, adalimumab, golimumab, infliximab, certolizumab pegol, natalizumab, vedolizumab, and ustekinumab. The drop down can be updated as needed in the
endoscopy reporting platform. Free text can be used to include medications not included in this list.
d
The panelists favored general descriptions of mild, moderate, or severe symptoms as designated at the discretion of the endoscopist.
DI, disagreement index (see Methods); Med, median.

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Inflamm Bowel Dis  Volume 22, Number 6, June 2016 Recommendations for Quality Colonoscopy Reporting

TABLE 2. Findings and Interventions Relevant to All IBD Colonoscopies

Reporting Elements Importance Rating Feasibility Rating

Description of perianal examination

Description of whether DRE performed at the time of examination Med: 8; DI: 20.34 Med: 9; DI: 20.34
Description of pertinent positives/negatives regarding stigmata of perianal CD Med: 7.5; DI: 20.93 Med: 7.5; DI: 21.94
(fissures, fistulas, skin tags) in CDa
Anatomical extent of examination
Maximal extent of examination Med: 9; DI: 0.00 Med: 9; DI: 0.00
Ileal intubation? (yes/no) Med: 9; DI: 0.00 Med: 9; DI: 20.22
Rationale for failure to intubate the terminal ileum if applicableb Med: 7; DI: 10.00 Med: 7; DI: 20.60
Findings
Description of maximal extent of endoscopically visible disease (for UC only) Med: 9; DI: 20.34 Med: 9; DI: 0.00
Adequate description of degree of endoscopic disease activity in UC using Mayo Med: 8; DI: 20.71 Med: 7; DI: 20.59
endoscopy scorec
Adequate description of degree of endoscopic disease activity in CD using SES- Med: 7.5; DI: 20.71 Med: 7; DI: 10.00
CDd
The following are applicable only if polypoid lesions noted at colonoscopy (qualifying
elements differ slightly if indication is dysplasia surveillance versus disease activity
assessment where polypoid lesion is found)
Description of morphology and location of raised lesion (diminutive, sessile, Med: 9.0; DI: 20.22 Med: 8; DI: 20.34
pedunculated, flat, laterally spreading)
Description of whether lesion is in endoscopically colitic or noncolitic mucosa Med: 7.5; DI: 20.71 Med: 8; DI: 0.00
Description of completeness of endoscopic removal of polypoid lesion Med: 8; DI: 20.34 Med: 8; DI: 20.43
Description of technique of endoscopic removal of polypoid lesion (biopsy forceps, Med: 7; DI: 0.00 Med: 8; DI: 0.00
jumbo forceps, snare cautery, snare cautery with submucosal lifting, cold snare)
Description of whether biopsies obtained adjacent to polypoid lesions Med: 8; DI: 20.65 Med: 8; DI: 20.26
Description of any special techniques for visualization (NBI, iScan, dye spray Med: 7; DI: 20.60 Med: 8; DI: 20.93
chromoendoscopy, endomicroscopy)
Description of biopsies of flat mucosa
Description of segmental location of biopsies obtainede Med: 8.5; DI: 20.34 Med: 8; DI: 20.43
Description of the approximate number of biopsies obtained overallf Med: 7; DI: 20.71 Med: 7.5; DI: 21.94
Impression
A summary of findings is provided Med: 9; DI: 20.34 Med: 9; DI: 20.34
Summary should specifically address the stated indication for the procedure Med: 8; mean: 7.58; DI: 20.71 Med: 7; mean: 7.17; DI: 20.71
Recommendations
Explicit instructions should be provided on when and how to arrange a follow-up Med: 8; DI: 20.71 Med: 8; DI: 20.71
appointment

a
Description of stigmata of perianal CD met importance for criteria only in a CD colonoscopy and did not meet importance criteria in a UC colonoscopy.
b
Drop-down menu to include not attempted, strictured ileocecal valve, looping. Free text could be used to describe alternative rationale if not included in the list.
c
Use of Mayo endoscopy score deemed important after second round of voting (see Methods).
d
Use of SES-CD endoscopy score deemed important after second round of voting (see Methods).
e
This endoscopy element was statistically deemed important when the absolute indication was not dysplasia surveillance, but it did not meet criteria for inclusion when the indication was
purely dysplasia surveillance.
f
This endoscopy element was statistically deemed important when the absolute indication was dysplasia surveillance, but it did not meet criteria for inclusion when the indication was
disease activity assessment.
DI, disagreement index (see Methods); DRE, digital rectal examination; Med, median; NBI, narrow band imaging.

endoscopic extent of the examination, findings, and details regarding DISCUSSION

pathologic specimens. Inflammation was described using similar
terminology to the pouchitis disease activity index.20 Although
included on the basis of importance, there was disagreement as to
describing the specific IBD therapy at the time of the procedure.
Similarly, this element was deemed to be potentially less feasible.
Endoscopic evaluation of the patient with IBD is central to
clinical care and endoscopic findings, and their interpretation may
be influenced by therapies at the time of the procedure, anatomical
considerations, and other factors. No recommendations currently
exist for high-quality endoscopic reporting for IBD. Therefore,

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Devlin et al
TABLE 3. Elements Specific to a Colonoscopy in Patients with an Ileocolonic Anastomosis
Reporting Elements
Anatomical extent of examination
Maximal extent of examination
Intubation of neoterminal ileum? (Y/N)
Maximal distance of neoterminal ileal insertion (if applicable)
Rationale for failure to intubate the neoterminal ileum (if applicable)
Findings
Description of degree of anastomotic and neoterminal ileal inflammation using
Rutgeerts score or findings 2 and 3 (below)
Adequate description of anastomotic inflammation using general descriptorsa
Adequate description of neoterminal ileal inflammation using general descriptorsb
Segmental description of colonic/rectal inflammation if presentc
The above reflects specific anatomical consideration in patients with an ileocolonic anastomosis. All other recommended reporting metrics in other tables would still apply.
a
Recommended descriptors include ulceration present, ulceration absent, no stricture, stricture present but passable, stricture present and not passable.
b
Recommended descriptors include ulceration absent, ulceration present (aphthous, shallow, deep), quantification of ulceration (scattered, numerous), no stricture, stricture present but
passable, stricture present and not passable.
c
Use colonic parameters of SES-CD.
DI, disagreement index (see Methods); Med, median.
there is a need for guidance on what constitutes a high-quality
colonoscopy report for a patient with IBD that encompasses the
totality of the endoscopic procedure and its clinical implications.
This study attempts to comprehensively address reporting for
a majority of endoscopic procedures for patients with IBD.
Our study has several strengths, including the use of
a rigorous, validated methodology with panelist input from 15
geographically diverse expert IBD clinicians who all routinely
perform colonoscopies on patients with IBD.
A colonoscopy report should be complete but also succinct;
thus, one potential challenge with our recommendations is the
potential reporting burden of multiple elements. However, the
complexity of a patient with IBD requires the inclusion of
sufficient detail to avoid incomplete evaluation and optimally
inform clinical decision-making. It is worth noting that not all 48
elements would be included in every colonoscopy as recommen-
ded elements would be dependent on the scenario. Moreover, an
increasing number of colonoscopy reports are generated by
electronic reporting platforms. One advantage to identifying
specific reporting elements is that they can then be incorporated
into these platforms, thus directing a practitioner through the
recommended elements in a systematic and time-efficient fashion
(a sample report produced using an endoscopy reporting platform
can be seen in supplementary Fig. 1, Supplemental Digital
Content 2, http://links.lww.com/IBD/B249). An important ques-
tion worth addressing is the potential training required to compre-
hend the implementation of the elements and the time required to
fashion a quality report. We do not believe that formalized train-
ing would be required for most elements (outside of a practitioner
learning to use a particular reporting platform in general) as the
elements themselves are not novel in terms of most clinicians’ use
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Inflamm Bowel Dis  Volume 22, Number 6, June 2016
Importance Rating Feasibility Rating
Med: 9; DI: 20.22 Med: 9; DI: 20.34
Med: 9; DI: 20.34 Med: 9; DI: 20.34
Med: 8; DI: 20.71 Med: 7.5; DI: 20.88
Med: 8; DI: 20.93 Med: 8; DI: 20.43
Med: 8; DI: 20.71 Med: 5.5; DI: 2.35
Med: 7; DI: 20.71 Med: 8; DI: 20.71
Med: 7.5; DI: 20.71 Med: 8; DI: 20.71
Med: 8; DI: 20.71 Med: 7; DI: 20.60
of terminology. The one possible exception would be the use of
disease activity indices. However, both the SES-CD and the Mayo
score for UC are sufficiently simple that a practitioner would be
able to apply them consistently after a short period. In terms of the
length of time required to complete a report, this will vary de-
pending on the complexity of the indication and the findings.
However, when using an established reporting platform in which
these elements were incorporated into a test version, the authors
were able to complete a report in less than 5 minutes.
The panelists rated elements both on their importance and
the feasibility of reporting. Although elements included in the
final set were selected solely on the basis of importance, we note
that 3 elements were deemed to be less feasible (i.e., a feasibility
rating ,7). These included naming specific IBD therapy at the
time of the procedure for both colonoscopy and pouchoscopy, and
the use of the Rutgeerts score in a patient with an ileocolonic
anastomosis. The apparent contradiction that general descriptors
of anastomotic and neoterminal ileal inflammation were deemed
to be feasible while the Rutgeerts score was deemed less feasible
is due to an initial bias against defined scoring systems (including
the Mayo score for UC and the SES-CD for CD). Initially, it was
believed that a general description was sufficient for a quality
report. However, as noted above in findings and interventions,
we eventually recognized that any internal attempt at proposed
general descriptors mirrored the established indices so the authors
opted to favor the Mayo score and the SES-CD. As a general
description of the neoterminal ileum is less complicated, we
accepted either good general descriptors or the Rutgeerts score
in the context of an ileocolonic anastomosis. As inclusion was
based solely on importance, we believed that feasibility was less
important. Ultimately, the authors believe that either approach is
Inflamm Bowel Dis  Volume 22, Number 6, June 2016 Recommendations for Quality Colonoscopy Reporting

TABLE 4. Reporting Elements Specific to Pouchoscopy

Candidate Reporting Metric Importance Rating Feasibility Rating

Disease background
Indication for procedurea Med: 9; DI: 0.00 Med: 8.5; DI: 20.34
Specific IBD therapy at the time of procedureb Med: 7; DI: 24 Med: 6.5; DI: 29.00
Symptoms at the time of evaluationc Med: 8; DI: 20.71 Med: 8; DI: 20.71
Description of perianal findings
Description of whether DRE performed at the time of examination Med: 9; DI: 0.00 Med: 9; DI: 0.00
Description of pertinent positives/negatives regarding stigmata of perianal CD Med: 9; DI: 0.00 Med: 9; DI: 0.00
(fissures, fistulas, skin tags)
Anatomical extent of examination
Maximal pouch insertion (cm) Med: 8; DI: 20.34 Med: 8; DI: 20.34
Intubation of prepouch ileum (Y/N) Med: 8; DI: 20.34 Med: 8; DI: 20.34
Maximal distance of prepouch ileal intubation (cm) Med: 7.3; DI: 20.43 Med: 7.3; DI: 20.72
Rationale for failure of intubation of prepouch ileum (if applicable)d Med: 7; DI: 20.71 Med: 7.5; DI: 20.71
Findings
Description of distribution and nature of pouch inflammatione,f Med: 8.5; DI: 20.34 Med: 8; DI: 20.34
Description of whether cuff is present Med: 7.5; DI: 20.71 Med: 7; DI: 10.00
Description of cuff mucosag Med: 7; DI: 20.71 Med: 7; DI: 20.60
Description of pouch inleth Med: 7; DI: 20.7 Med: 7.5; DI: 20.71
Description of prepouch ileumi Med: 8.5; DI: 20.34 Med: 8; DI: 20.65
Description of proximal prepouch ileum (.5 cm into prepouch ileum) j Med: 8; mean: 7.92; DI: 20.88 Med: 8; mean: 7.5; DI: 20.71
Details regarding pathologic specimens
Description of location of biopsies Med: 8; DI: 20.88 Med: 7; DI: 20.88
Description of whether cuff surveillance biopsies obtained Med: 7; DI: 20.71 Med: 8; DI: 20.93

a
Drop-down menu would include disease activity assessment and assess therapeutic response to therapy, dysplasia surveillance.
b
See descriptors in Table 1.
c
See descriptors in Table 2.
d
Drop-down menu to include not attempted, strictured pouch inlet. Free text could be used to describe alternative rationale if not included in the list.
e
Drop-down menu to include proximal pouch, midpouch, distal pouch, entire pouch.
f
Drop-down menu with descriptors: granularity, friability, loss of vascular pattern, mucous exudate, ulceration (endoscopist to select all that apply).
g
Drop-down menu to include normal, inflamed.
h
Drop-down menu to include ulceration present, ulceration absent, no stricture, stricture present but passable, stricture present and not passable.
i
Recommended descriptors include ulceration absent, ulceration present (aphthous, shallow, deep), quantification of ulceration (scattered, numerous), no stricture, stricture present but
passable, stricture present and not passable.
j
Recommended descriptors include ulceration absent, ulceration present (aphthous, shallow, deep), quantification of ulceration (scattered, numerous), no stricture, stricture present but
passable, stricture present and not passable.
DI, disagreement index (see Methods); DRE, digital rectal examination; Med, median.

appropriate and can equally be incorporated into existing elec-
tronic endoscopy platforms.
Our study has limitations. First, panelist ratings are based
on the opinions of the participants and not supported by clinical
evidence, as there were almost no studies to guide this process.
Second, the domains and scenarios do not include all possible
procedure permutations with respect to the endoscopic evaluation
of patients with IBD. For example, we did not include specific
elements germane to ileoscopy through a stoma or descriptors for
a patient with a colo-colonic anastomosis. However, the general
principles outlined in this study could be applied to all clinical
scenarios. Another limitation of our study is the lack of validation
with respect to proposed descriptors of anatomical segments.
Finally, the apparent discord regarding voting on the use of
disease activity indices could be seen as a limitation. However,
this reflects the challenge of adequately describing the disease
state in a consistent manner. We believe that any reasonable
attempt to enhance the description of the disease will lead to better
and more comprehensive reporting, even in the absence of
complete agreement on the optimal terminology.
Our study provides practical guidance on a set of elements
to include in a colonoscopy report for patients with IBD that will
provide a comprehensive overview of the totality of the disease
management that allows for proper interpretation of the findings
in the right context. This will also allow for better retrospective
evaluation of a colonoscopy report to guide current and even
future decisions. These reporting elements can be incorporated
into existing endoscopy reporting templates to facilitate efficient

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Devlin et al
documentation. We believe that the consistent inclusion of these
elements will improve the care of patients with IBD by more
precisely guiding therapeutic decision-making. As it is not
uncommon for therapeutic decisions to be made by practitioners
other than those who performed the procedure itself, or for
scenarios to arise whereupon treatment decisions are made based
on a retrospective review of a procedure report, we believe that
there is a potential for more informed decision-making and even
a reduction in repeat procedures being performed in the setting of
those patients being evaluated for a second opinion. However,
only a formal study evaluating outcomes in the context of
procedure reports of variable quality and detail would truly test
this assumption.
ACKNOWLEDGMENTS
The authors acknowledge the assistance of Michael
McMurtry who provided guidance on the incorporation of our
endoscopy reporting elements into the ProVation MD (ProVation
Medical, Minneapolis, MN) endoscopy reporting template after
the final set was defined. ProVation MD provided no financial
support toward the completion of this study and had no input into
its content or completion.
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