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Digital Cholangioscopic Interpretation: When North Meets the South

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Abstract

Background

Digital single‐operator cholangioscopy (DSOC) (SpyGlass DS™, Boston Scientific, MA, USA) allows for high‐definition imaging of the biliary tree. The superior visualization has led to the development of two different sets of criteria to evaluate and classify indeterminate biliary strictures: the Monaco criteria and the criteria in Carlos Robles–Medranda’s publication (CRM). Our objective was to assess the interrater agreement (IA) of DSOC interpretation for indeterminate biliary strictures using the two newly published criteria.

Methods

Forty de‐identified DSOC video recordings were sent to 15 interventional endoscopists with experience in cholangioscopy. They were asked to score the videos based on the presence of Monaco Classification criteria: stricture, lesion, mucosal changes, papillary projections, ulceration, white linear bands or rings, and vessels. Next, they scored the videos using CRM criteria: villous pattern, polypoid pattern, inflammatory pattern, flat pattern, ulcerate pattern and honeycomb pattern. The endoscopists then diagnosed the recordings as neoplastic or non-neoplastic based on the criteria. Intraclass correlation (ICC) analysis was done to evaluate interrater agreement for both criteria set and final diagnosis.

Results

Recordings of 26 malignant lesions and 14 benign lesions were scored. The IA using both the Monaco criteria and CRM criteria ranged from poor to excellent (range 0.1–0.76) and (range 0.1–0.62), respectively. Within the Monaco criteria, IA was excellent for lesion (0.75) and fingerlike papillary projections (0.74); good for tortuous vessels (0.7), mucosal features (0.62), uniform papillary projections (0.53), and ulceration (0.58); and fair for white linear bands (0.4). Within the CRM criteria, the IA was good for villous pattern (0.62), flat pattern (0.62), and honeycomb pattern; fair for ulcerated pattern (0.56), polypoid pattern (0.52) and inflammatory pattern (0.54). The diagnostic IA using Monaco criteria was good (0.65), while the diagnostic IA using CRM was fair (0.58). The overall diagnostic accuracy using the Monaco classification was 61% and CRM criteria were 57%.

Conclusion

The IOA and accuracy rate of DSOC using visual criteria from both Monaco Criteria and CRM are similar. However, some criteria from both sets suffer from poor IA, thus affecting the overall diagnostic accuracy. More formal training and refinements in visual criteria with additional validation are needed to improve diagnostic accuracy.

Trial Registration

ClinicalTrials.gov Identifier: NCT02166099.

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Authors and Affiliations

  1. Department of Medicine, Rutgers Robert Wood Johnson Medical School, Robert Wood Johnson University Hospital, Rutgers University, 1 RWJ Place, MEB 464, New Brunswick, NJ, 08901, USA

    Michel Kahaleh, Monica Gaidhane, Amy Tyberg, Haroon Shahid & Avik Sarkar

  2. Gastroenterology, Greater Houston Gastroenterology, Houston, USA

    Isaac Raijman

  3. Columbia University Medical Center, New York, USA

    Amrita Sethi

  4. Gastroenterology, University of Pittsburgh Medical Center, Pittsburgh, USA

    Adam Slivka

  5. Gastroenterology, University of Utah Health, Salt Lake City, USA

    Douglas G. Adler

  6. Baylor College of Medicine Houston, Long Island, USA

    Divyesh Sejpal

  7. Hospital Israelita Albert Einstein, São Paulo, Brazil

    Fernanda Martins

  8. Saint Louis University School of Medicine, St. Louis, MO, USA

    Christine Boumitri & Samuel Burton

  9. NuovoOspedale Civile S. Agostino Endoscopy Unit, Dr., Baggiovara, Italy

    Helga Bertani

  10. Digestive Health Associates of Texas, Dallas, USA

    Paul Tarnasky & Prashant Kedia

  11. Division of Digestive and Liver Diseases, Columbia University, New York, USA

    Frank Gress

  12. Vancouver General Hospital, GI, Vancouver, Canada

    Ian Gan

  13. HCFMRP-USP Department of Surgery and Anatomy, Surgery and Anatomy of HCFMRP-USP, São Paulo, Brazil

    Jose C. Ardengh

  14. Department of Upper Gastrointestinal Diseases, Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden

    Urban Arnelo

  15. Gastroenterology/Medicine, Yale University, Guilford, USA

    Priya Jamidar

  16. Gastroenterology, University of Colorado, Aurora, USA

    Raj J. Shah

  17. Instituto Ecuatoriano De Enfermedades Digestivas (IECED)-University Hospital Omni, Espiritu Santo University, Guayaquil, Ecuador

    Carlos Robles-Medranda

Authors
  1. Michel Kahaleh
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  2. Isaac Raijman
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  3. Monica Gaidhane
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  4. Amy Tyberg
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  5. Amrita Sethi
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  9. Haroon Shahid
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  11. Fernanda Martins
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  12. Christine Boumitri
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  13. Samuel Burton
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  14. Helga Bertani
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  15. Paul Tarnasky
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  16. Frank Gress
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  17. Ian Gan
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  18. Jose C. Ardengh
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  19. Prashant Kedia
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  20. Urban Arnelo
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  21. Priya Jamidar
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  22. Raj J. Shah
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  23. Carlos Robles-Medranda
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Corresponding author

Correspondence to Michel Kahaleh.

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Conflict of interest

Amy Tyberg: Consultant for Ninepoint Medical, Endogastric Solutions, Obalon Therapeutics. She is a director of Therapeutic Endoscopic Ultrasound society. Adam Slivka, Divyesh Sejpal, Raj Shah: Consultant for Boston Scientific and Olympus Medical. Douglas G Adler: Consultant for Boston Scientific. Isaac Raijman: Speaker for Boston Scientific, ConMed, Medtronic and GI Supplies. He is on the advisory board of Microtech. And he is a coowner of EndoRx. Paul Tarnasky, Prashant Kedia: Consultant and speaker for Boston Scientific. Michel Kahaleh: Consulting work for Boston Scientific, Interscope Med, ERBE, Medrobotic and AbbVie. He has received research grants from Boston Scientific, Conmed, Pinnacle, Cook, Gore, Merit, and Olympus. He is the CEO and Founder of Innovative Digestive Health Education & Research Inc., and Therapeutic Endoscopic Ultrasound Society. Monica Gaidhane: Consulting work for Interscope Med and Capvision. She is the COO of Therapeutic Endoscopic Ultrasound Society and Innovative Digestive Health Education & Research Inc. Avik Sarkar: Director of Obesity Coalition Inc. The remaining authors declare that they have nothing to disclose.

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This project was presented as a poster at United European Gastroenterology (UEG) Week 2019 Vienna.

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Kahaleh, M., Raijman, I., Gaidhane, M. et al. Digital Cholangioscopic Interpretation: When North Meets the South. Dig Dis Sci 67, 1345–1351 (2022). https://doi.org/10.1007/s10620-021-06961-z

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  • DOI: https://doi.org/10.1007/s10620-021-06961-z

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