Amrita Sethi1, Amy Tyberg2, Adam Slivka3, Douglas G Adler4, Amit P Desai1, Divyesh V Sejpal5, Douglas K Pleskow6, Helga Bertani7, Seng-Ian Gan8, Raj Shah9, Urban Arnelo10, Paul R Tarnasky11, Subhas Banerjee12, Takao Itoi13, Jong Ho Moon14, Dong Choon Kim14, Monica Gaidhane2, Isaac Raijman15, Bret T Peterson16, Frank G Gress17, Michel Kahaleh2. 1. Columbia University Medical Center, New York City. 2. Department of Medicine, Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ. 3. University of Pittsburgh Medical Center, Pittsburgh, PA. 4. University of Utah School of Medicine, Salt Lake City, UT. 5. North Shore-LIJ Health System, Manhattan. 6. Beth Israel Deaconess Medical Center, Boston, MA. 7. Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy. 8. Virginia Mason Medical Center, Seattle, WA. 9. University of Colorado, Denver, CO. 10. Karolinska Institutet, Solna, Sweden. 11. Methodist Dallas Medical Center, Dallas. 12. Veteran Affairs/Stanford University, Stanford, CA. 13. Tokyo Medical University, Tokyo, Japan. 14. Soon Chun Hyang School of Medicine, Chungcheongnam-do, Republic of Korea. 15. Greater Houston Gastroenterology, Houston, TX. 16. Mayo Clinic, Rochester, MN. 17. Mount Sinai Hospital, NY.
Abstract
BACKGROUND: Visual characteristics seen during digital single-operator cholangioscopy (DSOC) have not been validated. The aim of this 2-phase study was to define terminology by consensus for the visual diagnosis of biliary lesions to develop a model for optimization of the diagnostic performance of DSOC. MATERIALS AND METHODS: In phase 1 (criteria identification), video-cholangioscopy clips were reviewed by 12 expert biliary endoscopists, who were blinded to the final diagnosis. Visual criteria were consolidated into the following categories: (1) stricture, (2) lesion, (3) mucosal features, (4) papillary projections, (5) ulceration, (6) abnormal vessels, (7) scarring, (8) pronounced pit pattern.During the second phase (validation), 14 expert endoscopists reviewed DSOC (SpyGlass DS, Boston Scientific) clips using the 8 criteria to assess interobserver agreement (IOA) rate. RESULTS: In phase 1, consensus for visual findings were categorized into 8 criteria titled the "Monaco Classification." The frequency of criteria were: (1) presence of stricture-75%, (2) presence of lesion type-55%, (3) mucosal features-55%, (4) papillary projections-45%, (5) ulceration-42.5%, (6) abnormal vessels-10%, (7) scarring-40%, and (8) pronounced pit pattern-10%. The accuracy on final diagnosis based on visual impression alone was 70%.In phase 2, the IOA rate using Monaco Classification criteria ranged from slight to fair. The presumptive diagnosis IOA was fair (κ=0.31, SE=0.02), and overall diagnostic accuracy was 70%. CONCLUSIONS: The Monaco classification identifies 8 visual criteria for biliary lesions on single-operator digital cholangioscopy. Using the criteria, the IOA and diagnostic accuracy rate of DSOC is improved compared with prior studies.
BACKGROUND: Visual characteristics seen during digital single-operator cholangioscopy (DSOC) have not been validated. The aim of this 2-phase study was to define terminology by consensus for the visual diagnosis of biliary lesions to develop a model for optimization of the diagnostic performance of DSOC. MATERIALS AND METHODS: In phase 1 (criteria identification), video-cholangioscopy clips were reviewed by 12 expert biliary endoscopists, who were blinded to the final diagnosis. Visual criteria were consolidated into the following categories: (1) stricture, (2) lesion, (3) mucosal features, (4) papillary projections, (5) ulceration, (6) abnormal vessels, (7) scarring, (8) pronounced pit pattern.During the second phase (validation), 14 expert endoscopists reviewed DSOC (SpyGlass DS, Boston Scientific) clips using the 8 criteria to assess interobserver agreement (IOA) rate. RESULTS: In phase 1, consensus for visual findings were categorized into 8 criteria titled the "Monaco Classification." The frequency of criteria were: (1) presence of stricture-75%, (2) presence of lesion type-55%, (3) mucosal features-55%, (4) papillary projections-45%, (5) ulceration-42.5%, (6) abnormal vessels-10%, (7) scarring-40%, and (8) pronounced pit pattern-10%. The accuracy on final diagnosis based on visual impression alone was 70%.In phase 2, the IOA rate using Monaco Classification criteria ranged from slight to fair. The presumptive diagnosis IOA was fair (κ=0.31, SE=0.02), and overall diagnostic accuracy was 70%. CONCLUSIONS: The Monaco classification identifies 8 visual criteria for biliary lesions on single-operator digital cholangioscopy. Using the criteria, the IOA and diagnostic accuracy rate of DSOC is improved compared with prior studies.
Authors: Tiago Ribeiro; Miguel Mascarenhas Saraiva; João Afonso; João P S Ferreira; Filipe Vilas Boas; Marco P L Parente; Renato N Jorge; Pedro Pereira; Guilherme Macedo Journal: Clin Transl Gastroenterol Date: 2021-10-27 Impact factor: 4.488
Authors: Pedro Pereira; Miguel Mascarenhas; Tiago Ribeiro; João Afonso; João P S Ferreira; Filipe Vilas-Boas; Marco P L Parente; Renato N Jorge; Guilherme Macedo Journal: Endosc Int Open Date: 2022-03-14