Interobserver agreement for single operator choledochoscopy imaging: can we do better?

Area of Science:

• Gastroenterology
• Endoscopy
• Biliary Tract Diseases

Background:

• The SpyGlass Direct Visualization System facilitates single operator choledochoscopy (SOC) for identifying biliary lesions.
• Current diagnostic accuracy for SOC is reported up to 88%.

Purpose of the Study:

• To evaluate the interobserver agreement (IOA) of modified scoring criteria for diagnosing biliary lesions and strictures via SOC.
• To assess the reliability of current SOC imaging criteria.

Main Methods:

• Nine interventional endoscopists reviewed 27 SOC video clips.
• Scoring was based on published criteria assessing surface structure, vasculature, lesions, and findings.
• Interobserver agreement was quantified using Kappa (K) statistics.

Main Results:

• Overall IOA for all assessed variables was "slight" (K values ranging from 0.08 to 0.14).
• IOA for "findings" and "final diagnosis" was also "slight."
• The average diagnostic accuracy was less than 50%.

Conclusions:

• Modified SOC imaging criteria demonstrate poor interobserver agreement.
• Formal establishment and validation of imaging criteria for benign and malignant biliary pathology are necessary.
• Improved standardization is crucial for reliable SOC diagnoses.