Michel Kahaleh1, Monica Gaidhane1, Haroon M Shahid1, Amy Tyberg1, Avik Sarkar1, Jose Celso Ardengh2, Prashant Kedia3, Iman Andalib4, Frank Gress4, Amrita Sethi5, S Ian Gan6, Supriya Suresh7, Michael Makar1, Romy Bareket1, Adam Slivka8, Jessica L Widmer9, Priya A Jamidar10, Resheed Alkhiari11, Roberto Oleas12, Dongchoon Kim13, Carlos A Robles-Medranda12, Isaac Raijman14. 1. Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA. 2. Hospital das Clinicas da FMRPUSP, Ribeirão Preto, Brazil. 3. Methodist Dallas Medical Center, Dallas, Texas, USA. 4. Mount Sinai South Nassau, Oceanside, New York, USA. 5. Columbia University Medical Center, New York, New York, USA. 6. University of British Columbia, Vancouver, British Columbia, Canada. 7. Weill Cornell Medical College, New York, New York, USA. 8. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA. 9. NYU Winthrop, Mineola, New York, USA. 10. Yale University, New Haven, Connecticut, USA. 11. Department of Gastroenterology, Robert Wood Johnson University Hospital, New Brunswick, New Jersey, USA; Department of Medicine, Qassim University, Saudi Arabia. 12. Instituto Ecuatoriano de Enfermedades Digestivas, Guayaquil, Ecuador. 13. Soon Chun Hyang University Hospital, Seoul, Republic of Korea. 14. Baylor St Lukes Hospital, Houston, Texas, USA.
Abstract
BACKGROUND AND AIMS: Digital single-operator cholangioscopy (DSOC) allows direct visualization of the biliary tree for evaluation of biliary strictures. Our objective was to assess the interobserver agreement (IOA) of DSOC interpretation for indeterminate biliary strictures using newly refined criteria. METHODS: Fourteen endoscopists were asked to review an atlas of reference clips and images of 5 criteria derived from expert consensus. They then proceeded to score 50 deidentified DSOC video clips based on the visualization of tortuous and dilated vessels, irregular nodulations, raised intraductal lesions, irregular surface with or without ulcerations, and friability. The endoscopists then diagnosed the clips as neoplastic or non-neoplastic. Intraclass correlation (ICC) analysis was done to evaluate inter-rater agreement for both criteria sets and final diagnosis. RESULTS: Clips of 41 malignant lesions and 9 benign lesions were scored. Three of 5 revised criteria had almost perfect agreement. ICC was almost perfect for presence of tortuous and dilated vessels (.86), raised intraductal lesions (.90), and presence of friability (.83); substantial agreement for presence of irregular nodulations (.71); and moderate agreement for presence of irregular surface with or without ulcerations (.44). The diagnostic ICC was almost perfect for neoplastic (.90) and non-neoplastic (.90) diagnoses. The overall diagnostic accuracy using the revised criteria was 77%, ranging from 64% to 88%. CONCLUSIONS: The IOA and accuracy rate of DSOC using the new Mendoza criteria shows a significant increase of 16% and 20% compared with previous criteria. The reference atlas helps with formal training and may improve diagnostic accuracy. (Clinical trial registration number: NCT02166099.).
BACKGROUND AND AIMS: Digital single-operator cholangioscopy (DSOC) allows direct visualization of the biliary tree for evaluation of biliary strictures. Our objective was to assess the interobserver agreement (IOA) of DSOC interpretation for indeterminate biliary strictures using newly refined criteria. METHODS: Fourteen endoscopists were asked to review an atlas of reference clips and images of 5 criteria derived from expert consensus. They then proceeded to score 50 deidentified DSOC video clips based on the visualization of tortuous and dilated vessels, irregular nodulations, raised intraductal lesions, irregular surface with or without ulcerations, and friability. The endoscopists then diagnosed the clips as neoplastic or non-neoplastic. Intraclass correlation (ICC) analysis was done to evaluate inter-rater agreement for both criteria sets and final diagnosis. RESULTS: Clips of 41 malignant lesions and 9 benign lesions were scored. Three of 5 revised criteria had almost perfect agreement. ICC was almost perfect for presence of tortuous and dilated vessels (.86), raised intraductal lesions (.90), and presence of friability (.83); substantial agreement for presence of irregular nodulations (.71); and moderate agreement for presence of irregular surface with or without ulcerations (.44). The diagnostic ICC was almost perfect for neoplastic (.90) and non-neoplastic (.90) diagnoses. The overall diagnostic accuracy using the revised criteria was 77%, ranging from 64% to 88%. CONCLUSIONS: The IOA and accuracy rate of DSOC using the new Mendoza criteria shows a significant increase of 16% and 20% compared with previous criteria. The reference atlas helps with formal training and may improve diagnostic accuracy. (Clinical trial registration number: NCT02166099.).
Authors: Amy Tyberg; Isaac Raijman; Monica Gaidhane; Arvind J Trindade; Haroon Shahid; Avik Sarkar; Jason Samarasena; Iman Andalib; David L Diehl; Douglas K Pleskow; Kevin E Woods; Stuart R Gordon; Rahul Pannala; Prashant Kedia; Peter V Draganov; Paul R Tarnasky; Divyesh V Sejpal; Nikhil A Kumta; Gulshan Parasher; Douglas G Adler; Kalpesh Patel; Dennis Yang; Uzma Siddiqui; Michel Kahaleh; Viren Joshi Journal: Endosc Int Open Date: 2022-08-15