Digital single-operator cholangioscopy interobserver study using a new classification: the Mendoza Classification (with video)

TY - JOUR

T1 - Digital single-operator cholangioscopy interobserver study using a new classification

T2 - the Mendoza Classification (with video)

AU - Gaidhane, Monica

AU - Shahid, Haroon M.

AU - Tyberg, Amy

AU - Sarkar, Avik

AU - Ardengh, Jose Celso

AU - Kedia, Prashant

AU - Andalib, Iman

AU - Gress, Frank

AU - Sethi, Amrita

AU - Gan, S. Ian

AU - Suresh, Supriya

AU - Makar, Michael

AU - Bareket, Romy

AU - Slivka, Adam

AU - Widmer, Jessica L.

AU - Jamidar, Priya A.

AU - Alkhiari, Resheed

AU - Oleas, Roberto

AU - Kim, Dongchoon

AU - Robles-Medranda, Carlos A.

AU - Raijman, Isaac

N1 - Publisher Copyright: © 2022 American Society for Gastrointestinal Endoscopy

PY - 2022/2

Y1 - 2022/2

N2 - 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.)

AB - 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.)

UR - https://www.scopus.com/pages/publications/85122939307

UR - https://www.scopus.com/pages/publications/85122939307#tab=citedBy

U2 - 10.1016/j.gie.2021.08.015

DO - 10.1016/j.gie.2021.08.015

M3 - Article

C2 - 34478737

SN - 0016-5107

VL - 95

SP - 319

EP - 326

JO - Gastrointestinal Endoscopy

JF - Gastrointestinal Endoscopy

IS - 2

ER -