title: Interobserver agreement for evaluation of imaging with single operator choledochoscopy: what are we looking at?
abstract: BACKGROUND
  Single operator choledochoscopy is a platform used to assist in the confirmation of diagnosis of biliary lesions. However, there are little data regarding the interobserver agreement of imaging interpretation. Our objective was to assess the interobserver agreement in single operator choledochoscopy interpretation.
  
  
  METHODS
  38 De-identified SPY Choledochoscopy video clips were sent to 7 interventional endoscopists. They were asked to score the videos on presence of four criteria selected by the investigators: growth, stricture, hyperplasia, and ulceration. Observers also chose a final diagnosis from the categories of cancer, hyperplasia, inflammation, or normal. Kappa scores were calculated for the scoring of the four criteria and for the selection of the final diagnosis.
  
  
  RESULTS
  The overall interobserver agreement was fair in scoring for the presence of a growth (K=0.28, SE 0.035) and stricture (K=0.32, SE 0.035). Scoring for ulceration was slight to fair (K=0.17, SE 0.035). There was only slight agreement for the presence of hyperplasia (K=0.11, SE 0.035); and presumed final diagnosis based on imaging (K=0.18, SE 0.022).
  
  
  CONCLUSIONS
  The results of this study support the need for an effort to identify and validate cholangioscopy imaging criteria for biliary pathology. This may assist in improving the reliability of the diagnostic value of cholangioscopy as its use becomes more widespread.
authors.affiliation: Division of Digestive and Liver Disease, Columbia University Medical Center-NYPH, New York, NY, United States.
authors.forename: Amrita
authors.initials: A
authors.lastname: Sethi
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Jessica
authors.initials: J
authors.lastname: Widmer
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, United States.
authors.forename: Neeral L
authors.initials: NL
authors.lastname: Shah
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, United States.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Pleskow
authors.affiliation: Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO, United States.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Edmundowicz
authors.affiliation: Division of Gastroenterology, North Shore LIJ Health System, Manhasset, NY, United States.
authors.forename: Divyesh V
authors.initials: DV
authors.lastname: Sejpal
authors.affiliation: Division of Digestive and Liver Disease, Columbia University Medical Center-NYPH, New York, NY, United States.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Gress
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: George H
authors.initials: GH
authors.lastname: Pop
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States.
authors.forename: Monica
authors.initials: M
authors.lastname: Gaidhane
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA, United States.
authors.forename: Bryan G
authors.initials: BG
authors.lastname: Sauer
authors.affiliation: Division of Digestive and Liver Disease, Columbia University Medical Center-NYPH, New York, NY, United States.
authors.forename: Peter D
authors.initials: PD
authors.lastname: Stevens
authors.affiliation: Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, NY, United States. Electronic address: mkahaleh@gmail.com.
authors.forename: Michel
authors.initials: M
authors.lastname: Kahaleh
mesh_terms: D000328:Adult; D000368:Aged; D001652:Bile Ducts / Q000473:pathology*; D001660:Biliary Tract Diseases / Q000175:diagnosis*; D003251:Constriction, Pathologic / Q000175:diagnosis; D016145:Endoscopy, Digestive System / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D006965:Hyperplasia / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D014456:Ulcer / Q000175:diagnosis*; D014741:Video Recording; D055815:Young Adult
keywords: Cholangioscopy; Choledochoscopy; SOC; SpyGlass