Is size, morphology, site, and access scoring system consistent between endoscopists? Interobserver and intraobserver...

Area of Science:

• Gastroenterology
• Endoscopic assessment
• Medical device usability

Background:

• The Size/Morphology/Site/Access (SMSA) scoring system is used in colonoscopy.
• Evaluating the consistency of SMSA scoring among endoscopists is crucial for its reliable application.

Purpose of the Study:

• To assess interobserver and intraobserver agreement in SMSA scoring among endoscopists with varied experience levels.
• To identify which SMSA parameters demonstrate the highest agreement.

Main Methods:

• 102 endoscopists scored 10 colonic polyp video clips using the SMSA tool.
• Videos utilized various imaging modalities (white light, NBI, chromoendoscopy).
• Fleiss' kappa statistic analyzed interobserver agreement; a subgroup assessed intraobserver reliability.

Main Results:

• Overall interobserver agreement for SMSA was fair (κ = 0.346).
• Morphology (κ = 0.505) showed the highest agreement, followed by access (κ = 0.408) and size (κ = 0.241).
• Experienced endoscopists showed slightly better agreement; intraobserver agreement ranged from moderate to almost perfect.

Conclusions:

• Morphology is the most consistently scored SMSA parameter.
• While valuable, the SMSA tool may benefit from standardized training and simplified categories to enhance consistency and clinical utility.