Low interobserver agreement among endoscopists in differentiating dysplastic from non-dysplastic lesions during inflammatory bowel disease colitis surveillance

Wanders, Linda K; Mooiweer, Erik; Wang, Junfeng; Bisschops, Raf; Offerhaus, G. J. A.; Siersema, Peter D.; D’Haens, Geert R.; Oldenburg, Bas; Dekker, Evelien

doi:10.3109/00365521.2015.1016449

Cited by 12 publications

(8 citation statements)

References 26 publications

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“…The use of still images, instead of video sequences, can be criticized since the latter better mimics the clinical duodenoscopy situation. Previous studies in the field of endoscopic validation studies have, however, used still images of good quality and found these to be of sufficient value, not the least from a study logistic perspective 12 , 15 . Video sequences are hampered by the fact that they are time‐consuming to watch and evaluate and are often difficult to produce and reproduce with optimal image quality and proper freeze framing.…”

Section: Discussionmentioning

confidence: 99%

“…In the field of gastrointestinal endoscopy, several previous studies have dealt with endoscopists lack of concordance in image interpretation regarding specific pathological conditions. These issues have been addressed in oesophageal varices, 6 Barrett’s oesophagus, 7 , 8 oesophagitis, 9 , 10 eosinophilic oesophagitis, 11 , 12 bleeding peptic ulcers, 13 ulcerative colitis 14 and dysplastic lesions in the colon 15 with varying outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

et al. 2017

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Background: Many endoscopists acknowledge that the appearance of the papilla of Vater seems to affect biliary cannulation. To assess the association between the macroscopic appearance of the papilla and biliary cannulation and other related clinical issues, a system is needed to define the appearance of the papilla. Objective: The purpose of this study was to validate an endoscopic classification of the papilla of Vater by assessing the interobserver and intraobserver agreements among endoscopist with varying experience. Methods: An endoscopic classification, based on pictures captured from 140 different papillae, containing four types of papillae was proposed. The four types are (a) Type 1: regular papilla, no distinctive features, 'classic appearance'; (b) Type 2: small papilla, often flat, with a diameter 3 mm (approximately 9 Fr); (c) Type 3: protruding or pendulous papilla, a papilla that is standing out, protruding or bulging into the duodenal lumen or sometimes hanging down, pendulous with the orifice oriented caudally; and (d) Type 4: creased or ridged papilla, where the ductal mucosa seems to extend distally, rather out of the papillary orifice, either on a ridge or in a crease. To assess the level of interobserver agreement, a web-based survey was sent out to 18 endoscopists, containing 50 sets of still images of the papilla, distributed between the four different types. Three months later a follow-up survey, with images from the first survey was sent to the same endoscopists. Results: Interobserver agreement was substantial (k ¼ 0.62, 95% confidence interval (CI) 0.58-0.65) and were similar for both experts and non-experts. The intraobserver agreement assessed with the second survey was also substantial (k ¼ 0.66, 95% CI 0.59-0.72). Conclusion: The proposed endoscopic classification of the papilla of Vater seems to be easy to use, irrespective of the level of experience of the endoscopist. It carries a substantial inter-and intraobserver agreement and now the clinical relevance of the four different papilla types awaits to be determined.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

et al. 2017

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“…This low inter-observer agreement in differentiating dysplastic from non-dysplastic lesions has also been reported in another image-based study. 33 The results of these studies emphasise that there is considerable disagreement in optical diagnosis of dysplasia by specialist endoscopists using several advanced imaging techniques. It is likely that this can be extrapolated to general endoscopy practice.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Accuracy of Endoscopic Trimodal Imaging and Chromoendoscopy for Lesion Characterization in Ulcerative Colitis

Vleugels¹,

Rutter²,

Ragunath³

et al. 2019

Journal of Crohn's and Colitis

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Background: Patients with longstanding ulcerative colitis (UC) are at increased risk for developing CRC.During surveillance colonoscopy, a variety of dysplastic and non-dysplastic lesions are detected. The aim of this study was to address the diagnostic accuracy of endoscopic differentiation autofluorescence imaging (AFI), narrow band imaging (NBI) and chromoendoscopy (CE).Methods: This is a pre-specified additional analysis of a multicentre randomised controlled trial that compared AFI with CE for dysplasia detection in 210 patients with longstanding UC (FIND-UC trial). In the AFI arm, endoscopists recorded AFI color and Kudo pit pattern using NBI. Kudo pit pattern was described in the CE arm. For AFI, purple colour and ambiguous colour combined with pit pattern type III-V on NBI was considered dysplastic. For pit pattern description using NBI and CE, type III-V was considered dysplastic. Histology was the reference standard; sessile serrated lesions without dysplasia were considered non-dysplastic.Results: In total, 52 dysplastic and 255 non-dysplastic lesions were detected. Overall sensitivity for real-time prediction of dysplasia was 76.9% (95% confidence interval (CI) 46.2-95.0) for NBI and AFI combined, and 81.6% (95% CI 65.7-92.3) for CE (p=0.72). For high confidence predictions, negative predictive value (NPV) of the combination of AFI and NBI was 97.7% (95% CI 92.4-99.3) versus 97.4% (95% CI 90.2-97.2) for CE (p=0.41).Interpretation: Sensitivity for endoscopic differentiation of dysplastic lesions detected during surveillance of patients with longstanding UC seems limited. The high NPV using these techniques may be sufficient to leave suspected non-dysplastic lesions in situ without biopsy (NTR4062).

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“…15 Interestingly, no hyperplastic polyps were included in the Kudo paper, but only 2.8% of the adenomas exhibited a type I/II non-neoplastic pattern. A more recent image based study assessed the diagnostic accuracy of low-grade dysplasia in patients with inflammatory bowel disease based on non-magnified HD-CE 17 . These authors had 30 (13 low grade dysplasia) lesions assessed by 17 endoscopists.…”

Section: Discussionmentioning

confidence: 99%

“…The selected images were originating from 27 different patients with longstanding UC undergoing surveillance endoscopy [9/27 (33%) female, median (interquartile range, IQR) disease duration at index endoscopy 16 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) years]. The maintenance therapy consisted of mesalamine in 18 (67%), a thiopurine in 7 (26%), and/or a biologic in 11 (41%) patients.…”

Section: Selection Of Endoscopic Imagesmentioning

confidence: 99%

Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis

Bisschops

Bessissow

Dekker³

et al. 2017

Gastrointestinal Endoscopy

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Differentiation between non-neoplastic and neoplastic pit patterns in UC lesions shows a moderate to substantial agreement among expert endoscopists. The agreement for differentiating neoplastic from non-neoplastic lesions is significantly better for NBI in comparison with HD CE. The assessment of pit pattern I or II with nonmagnified HD CE or NBI has a high negative predictive value to rule out neoplasia. (Clinical trial registration number: NCT01882205.).

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Low interobserver agreement among endoscopists in differentiating dysplastic from non-dysplastic lesions during inflammatory bowel disease colitis surveillance

Cited by 12 publications

References 26 publications

Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

Endoscopic classification of the papilla of Vater. Results of an inter‐ and intraobserver agreement study

Diagnostic Accuracy of Endoscopic Trimodal Imaging and Chromoendoscopy for Lesion Characterization in Ulcerative Colitis

Pit pattern analysis with high-definition chromoendoscopy and narrow-band imaging for optical diagnosis of dysplasia in patients with ulcerative colitis

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