Digital Single-operator Cholangioscopy (DSOC) Improves Interobserver Agreement (IOA) and Accuracy for Evaluation of Indeterminate Biliary Strictures: The Monaco Classification.

Autor:	Sethi A; Columbia University Medical Center, New York City., Tyberg A; Department of Medicine, Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ., Slivka A; University of Pittsburgh Medical Center, Pittsburgh, PA., Adler DG; University of Utah School of Medicine, Salt Lake City, UT., Desai AP; Columbia University Medical Center, New York City., Sejpal DV; North Shore-LIJ Health System, Manhattan., Pleskow DK; Beth Israel Deaconess Medical Center, Boston, MA., Bertani H; Nuovo Ospedale Civile S. Agostino Estense, Modena, Italy., Gan SI; Virginia Mason Medical Center, Seattle, WA., Shah R; University of Colorado, Denver, CO., Arnelo U; Karolinska Institutet, Solna, Sweden., Tarnasky PR; Methodist Dallas Medical Center, Dallas., Banerjee S; Veteran Affairs/Stanford University, Stanford, CA., Itoi T; Tokyo Medical University, Tokyo, Japan., Moon JH; Soon Chun Hyang School of Medicine, Chungcheongnam-do, Republic of Korea., Kim DC; Soon Chun Hyang School of Medicine, Chungcheongnam-do, Republic of Korea., Gaidhane M; Department of Medicine, Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ., Raijman I; Greater Houston Gastroenterology, Houston, TX., Peterson BT; Mayo Clinic, Rochester, MN., Gress FG; Mount Sinai Hospital, NY., Kahaleh M; Department of Medicine, Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ.
Jazyk:	angličtina
Zdroj:	Journal of clinical gastroenterology [J Clin Gastroenterol] 2022 Feb 01; Vol. 56 (2), pp. e94-e97.
DOI:	10.1097/MCG.0000000000001321
Abstrakt:	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. (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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