Education can improve inter-observer agreement in double balloon endoscopy assessment

Area of Science:

• Gastroenterology
• Endoscopy
• Diagnostic Accuracy

Background:

• Diagnosing small bowel lesions via double balloon endoscopy (DBE) is challenging due to subtle findings like tiny lesions or erythema.
• These findings can be misattributed to pathology or artifact from the endoscopic procedure itself.

Purpose of the Study:

• To evaluate the inter-observer agreement among endoscopists in interpreting DBE findings.
• To determine if endoscopist education can enhance the consistency of DBE assessments.

Main Methods:

• Three experienced endoscopists independently reviewed 124 DBE images from 78 patients with suspected small bowel bleeding.
• Lesions were assessed for diagnosis and bleeding source, with tiny lesions evaluated under different detection scenarios (insertion/withdrawal).
• After consensus review sessions, the same endoscopists evaluated a validation set of 43 lesions from 30 patients.

Main Results:

• Initial inter-observer agreement for DBE assessment was moderate, but improved to a good level in the validation set.
• The rate of misclassifying lesions as contact trauma (detected during withdrawal) decreased in the second assessment.

Conclusions:

• While not perfect, inter-observer agreement in DBE assessment can be significantly improved through targeted endoscopist education.
• Education enhances diagnostic consistency, aiding in the accurate identification of small bowel pathologies.