Techniques and Innovations in Gastrointestinal Endoscopy最新文献

{"title":"Distal Cap-assisted Endoscopic Mucosal Resection for Non-lifting Colorectal Polyps: An International, Multicenter Study","authors":"Scott R. Douglas ,&nbsp;Douglas K. Rex ,&nbsp;Alessandro Repici ,&nbsp;Melissa Kelly ,&nbsp;J. Wes Heinle ,&nbsp;Marco Spadaccini ,&nbsp;Matthew T. Moyer","doi":"10.1016/j.tige.2023.03.009","DOIUrl":"https://doi.org/10.1016/j.tige.2023.03.009","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Submucosal fibrosis is a commonly encountered problem associated with complex polyps referred for endoscopic mucosal resection (EMR). Previous biopsies, submucosal tattoo injection, and previous unsuccessful attempts at polyp resection have all been shown to induce submucosal fibrosis, which makes subsequent EMR more difficult and increases the risk of recurrence.</p></div><div><h3>Methods</h3><p>We conducted a multicenter, international, retrospective study of 61 distal cap-assisted endoscopic mucosal resection (EMR-DC) cases done for the indication of a non-lifting colorectal lesion occurring after a previous biopsy, tattoo, or attempted resection at 3 tertiary referral centers.</p></div><div><h3>Results</h3><p>EMR-DC was preceded by attempted polypectomy<span> or EMR in 88.5% of cases, submucosal tattoo injection in 2%, previous biopsy in 5%, and both biopsy and tattoo in 5%. Complete macroscopic resection was achieved in 100% of EMR-DC procedures in an average procedure time of 49.5 minutes. The adenoma recurrence rate for these adherent lesions at surveillance (average 6.6 months) was only 9.8%. Two serious adverse events occurred (3.3%) within 30 days of the procedure: one instance of postprocedural bleeding and one episode of post-polypectomy syndrome.</span></p></div><div><h3>Conclusion</h3><p>This large, multicenter series demonstrates EMR-DC to be a safe, effective, and efficient approach to a difficult and common clinical problem: adherent and non-lifting polyps. It may offer several advantages over more expensive or invasive endoscopic techniques used for this indication. The use of EMR-DC for larger adherent polyps with adjuvant techniques such as hot avulsion or cold forceps avulsion with adjuvant snare tip soft coagulation for smaller adherent sections may represent an ideal approach.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 236-242"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Evaluation of a Standardized Approach to Improve Procedure Speed in Esophageal Endoscopic Submucosal Dissection","authors":"Firas Bahdi ,&nbsp;Michael M. Mercado ,&nbsp;Xiaofan Huang ,&nbsp;Kristen A. Staggers ,&nbsp;Noor Zabad ,&nbsp;Mohamed O. Othman","doi":"10.1016/j.tige.2023.01.006","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.006","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Endoscopic submucosal dissection (ESD) of esophageal lesions is limited by the lengthy procedure time, technique's complexity, and need for specialized training. We propose a standardized esophageal ESD technique that takes advantage of specimen self-retraction to improve visualization and procedure speed by starting the margins’ </span>incision at the anal side, followed by the laterals and the proximal.</p></div><div><h3>Methods</h3><p>This was a prospective clinical trial<span> of all consecutive patients who underwent a standardized esophageal ESD of esophageal lesions at a single tertiary referral center between December 2016 and January 2021. The primary outcome was the entire procedure speed calculated as centimeters squared per hour. Secondary outcomes included the rates of en bloc resection, R0 resection, and adverse events. Linear regression analysis was conducted to test the association between the entire procedure speed and tumor location, number of knives used, year of procedure, and pathology results.</span></p></div><div><h3>Results</h3><p>Thirty-two patients prospectively enrolled in our study. The mean patient age was 65 ± 10.9 years. The mean specimen surface area was 17.9 ± 12.7 cm². The mean entire procedure speed was 11 ± 5.9 cm²/h. The mean total procedure time was 93.5 ± 31 minutes. The entire procedure speed was significantly faster with procedures performed over the last 3 years (+5.86 cm²/h; <em>P</em><span> = 0.003) or Barrett's esophagus (+7.77 cm</span>²/h; <em>P</em> = 0.001). En-bloc and R0 resection rates were 100% and 68.8%, respectively. There were only 2 early bleeding events (6.3%) and 4 stricture formations (12.5%). All adverse events were successfully managed endoscopically.</p></div><div><h3>Conclusion</h3><p>Our standardized esophageal ESD technique offered our operator a remarkable entire procedure speed with continuous annual improvement and an acceptable safety profile. Future controlled multicenter studies are warranted to confirm the results’ generalizability and help promote wider adoption of esophageal ESD (ClinicalTrials.gov identifier: NCT04547881).</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 2","pages":"Pages 127-134"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749991","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Initial Experience With a Novel Flexible Endoscopic Robotic Device That Allows Full Resection of Colorectal Lesions and Suturing","authors":"Manoel Galvao Neto ,&nbsp;Andre Teixeira ,&nbsp;Romulo Lind ,&nbsp;Eduardo Grecco ,&nbsp;Thiago Ferreira Souza ,&nbsp;Luis Gustavo Quadros ,&nbsp;Fauze Maluf Filho","doi":"10.1016/j.tige.2022.09.002","DOIUrl":"https://doi.org/10.1016/j.tige.2022.09.002","url":null,"abstract":"<div><p><span>Conventional endoscopic instruments have intrinsic technical limitations, restraining surgeons’ ability to perform specific colorectal resections with lower complication rates and optimal oncologic results. Robotic transanal surgery has been a recent contribution, considered promising in terms of safety profile, technical learning curve, and oncologic outcomes, an alternative that can ergonomically improve surgeons’ ability to perform more complex procedures. The aim of this study is to report preliminary results regarding the feasibility, safety, and efficacy of ColubrisMX ELS, an endoluminal robotic system for complex polyps and incipient colorectal tumor<span> resection. This was a prospective, single-arm, multicenter study to evaluate the feasibility, safety, and efficacy of an endoluminal robotic system (ColubrisMX ELS) in 8 patients who underwent transanal procedures. All patients were followed up at 7, 30, and 60 days; complication, readmission, and conversion rates, as well as operative time and blood loss, were used to measure safety. Success rates were used to measure efficacy and encompassed the number of procedures performed with a complete tumor resection. Eight patients underwent robotic transanal surgery for local excision of benign or incipient neoplasia over a period of 5.5 months, with a success rate of 100%. Of these, 2 patients (25%) underwent conversions, 1 to manage hemorrhage using endoscopic clips and 1 to complete a </span></span>polypectomy with the cold snare technique. The mean operative time, from insertion to removal of the transanal flexible tube, was 184 minutes (min 79-max 537), whereas the mean length of hospital stay was 30 hours (min 24-max 144). This approach using a new platform represents a “work in progress” that has the potential to improve not only surgical ergonomics but also surgical outcomes.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 1","pages":"Pages 61-66"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49750401","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Today's Toolbox for Barrett's Endotherapy","authors":"Sagar N. Shah ,&nbsp;Jennifer M. Kolb","doi":"10.1016/j.tige.2023.02.001","DOIUrl":"https://doi.org/10.1016/j.tige.2023.02.001","url":null,"abstract":"<div><p><span>Barrett's esophagus<span><span><span> (BE) is characterized by the metaplastic transformation of the normal squamous epithelium of the distal esophagus to columnar-lined </span>mucosa with </span>intestinal metaplasia. BE is the only known precursor to </span></span>esophageal adenocarcinoma<span><span> (EAC). Given the rising incidence of EAC in recent decades, early detection, enrollment in surveillance programs, and effective treatment are critical. BE-related neoplasia and select early esophageal cancers should be treated with endoscopic </span>eradication therapy<span> (EET). The toolbox for BE endotherapy has grown tremendously alongside evolving techniques in resection and new ablative devices. The success of EET hinges on thoughtful patient selection, appropriate choice of therapeutic modality, and adherence to surveillance intervals including ongoing surveillance after BE eradication. We emphasize the importance of reflux optimization and the role of patient education and counseling throughout the process.</span></span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 2","pages":"Pages 167-176"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49759089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prospective Assessment of Clinical Criteria for Diagnosis and Severity of Acute Cholangitis","authors":"Ishani Shah ,&nbsp;Andy Silva-Santisteban ,&nbsp;Madhuri Chandnani ,&nbsp;Leo Tsai ,&nbsp;Abraham F. Bezuidenhout ,&nbsp;Tyler M. Berzin ,&nbsp;Douglas K. Pleskow ,&nbsp;Mandeep S. Sawhney","doi":"10.1016/j.tige.2023.01.007","DOIUrl":"https://doi.org/10.1016/j.tige.2023.01.007","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Reliable tools to diagnose and prognosticate acute cholangitis are needed to improve patient outcomes. We assessed the accuracy of 2 clinical criteria, Tokyo and BILE criteria, for the diagnosis and severity of acute cholangitis.</p></div><div><h3>Methods</h3><p><span>We identified all patients from 2020-2021 seen at our institution with suspected cholangitis, defined as having abdominal pain or fever, and abnormal liver enzymes or biliary abnormality on imaging studies. Patient </span>medical records were reviewed, and demographics, laboratory results, imaging findings, and procedure results were collected. To ascertain clinical outcomes, patients were followed until hospital discharge or for 30 days after presentation.</p></div><div><h3>Results</h3><p>During the study period, 175 patients with suspected acute cholangitis were prospectively identified. The average patient age was 69.6 years, 50.3% were women, and 115 met criteria standard for diagnosis of acute cholangitis. Intensive care admissions in 14.3%, mortality in 5.7%, and 30-day readmissions in 7.4% were observed. Tokyo diagnostic criteria for definite cholangitis had higher accuracy (64%), sensitivity (69.6%), and specificity (53.3%) when compared with BILE criteria, with an accuracy of 48.6% (<em>P</em><span><span><span> = 0.005), sensitivity of 42.61%, and specificity of 60%. Both criteria performed better in patients with </span>choledocholithiasis (80% and 51% accuracy) than in patients with preexisting biliary stents (56% and 41% accuracy). The Tokyo severity grading criteria for severe cholangitis had an accuracy of 67.83% and was highly predictive of in-hospital mortality and </span>ICU admission, but not 30-day readmission.</span></p></div><div><h3>Conclusion</h3><p>Tokyo criteria were more accurate than BILE criteria for acute cholangitis; however, neither criteria achieved high diagnostic accuracy, especially in patients with preexisting biliary stents.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 196-203"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49765286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel Functional Endoscopy for Visualization of the Anorectal Junction and Anal Canal","authors":"DAMING SUN ,&nbsp;HANS GREGERSEN","doi":"10.1016/j.tige.2023.03.006","DOIUrl":"10.1016/j.tige.2023.03.006","url":null,"abstract":"","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 297-299"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10506846/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closure of Mucosal Defects Using Endoscopic Suturing Following Endoscopic Submucosal Dissection: A Single-Center Experience","authors":"Osman Ali ,&nbsp;Andrew Canakis ,&nbsp;Yuting Huang ,&nbsp;Harsh Patel ,&nbsp;Madeline Alizadeh ,&nbsp;Raymond E. Kim","doi":"10.1016/j.tige.2022.11.002","DOIUrl":"10.1016/j.tige.2022.11.002","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Endoscopic submucosal dissection (ESD) is a therapeutic technique for en-bloc resection of both large (&gt;20 mm) and smaller, complex </span>gastrointestinal neoplasms<span>. ESD has a higher success rate of en-bloc resection and a lower rate of local recurrence compared with endoscopic mucosal resection<span>. Removal of lesions via ESD can leave large mucosal defects, raising unique challenges leading to adverse events. We aimed to determine clinical outcomes, including delayed bleeding, perforation, and hospitalization, in patients undergoing endoscopic suturing after ESD.</span></span></p></div><div><h3>Methods</h3><p>This was a single-center retrospective study of a prospectively collected database of consecutive adult patients who underwent ESD with mucosal defect closure using endoscopic suturing. Primary outcomes were adverse events, specifically delayed bleeding or perforation. Secondary outcomes included need for hospitalization and suturing complications.</p></div><div><h3>Results</h3><p><span>Fifty-five patients (mean age: 67 years) were included, with a mean lesion size of 27.4 ± 15 mm. Defect closure occurred in the esophagus (6), gastroesophageal junction (2), stomach (30), cecum (2), </span>sigmoid colon (2), and rectum (13). A mean of 1.8 ± 1.0 sutures were required for defect closure. The hospital admission rates was 14% (8/55), with an average length of stay 2 days (range 1-3 days). Intraprocedural perforation occurred in 2 patients, and both were successfully treated with endoscopic suturing. There was one case of delayed bleeding and no cases of delayed perforation or suturing complications.</p></div><div><h3>Conclusion</h3><p>The use of endoscopic suturing following ESD is a safe and clinically reliable method to close mucosal defects. This approach is associated with minimal adverse events and need for hospitalization. Larger studies are needed to further validate these findings.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 1","pages":"Pages 46-51"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10552729/pdf/nihms-1928463.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41132120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance Characteristics of Screening Criteria to Identify Patients at Risk of Barrett's Esophagus in a Primary Care Setting","authors":"Shashank Garg ,&nbsp;Usman Akbar ,&nbsp;Molly Stewart ,&nbsp;Alisha Menon ,&nbsp;Hye Jeong Jang ,&nbsp;Arvind J. Trindade","doi":"10.1016/j.tige.2023.07.001","DOIUrl":"https://doi.org/10.1016/j.tige.2023.07.001","url":null,"abstract":"<div><h3>Background and Aims</h3><p><span>Several criteria have been developed for screening of Barrett's esophagus (BE). Previous studies are limited by analysis in highly selective populations. This study evaluated the performance of 4 criteria in identifying patients with BE from a </span>primary care population.</p></div><div><h3>Methods</h3><p><span>This was a post-hoc analysis from a previous retrospective study reporting on BE screening rates of eligible patients in a large health system<span>. Patients were included if they were screened in a primary care population for BE, were at risk for BE per 1 of the accepted criteria, and underwent screening with esophagogastroduodenoscopy. Sensitivity for BE was calculated for 4 screening criteria. These included criteria from the American College of Gastroenterology (ACG), American Society of </span></span>Gastrointestinal Endoscopy (ASGE), European Society of Gastrointestinal Endoscopy (ESGE), and the Kunzmann model.</p></div><div><h3>Results</h3><p>In a primary care population, 1077 patients were screened for BE with an esophagogastroduodenoscopy. BE was found in 105 (9.75%) patients. Positive predictive values and negative predictive values of ACG/ESGE, ASGE, and Kunzmann's criteria for BE on pathology were 9.9% and 90.45%, 9.12% and 89.22%, and 10.84% and 92.29%, respectively. The area under the receiver operating characteristic curve for ACG/ESGE, ASGE, and Kunzmann's criteria was 50.49%, 52.23%, and 54.04%, respectively. There was no statistically significant difference in the presence of BE on pathology among patients who did or did not meet ACG/ESGE, ASGE, or Kunzmann's criteria for BE screening.</p></div><div><h3>Conclusion</h3><p>Current BE screening criteria need optimization in a primary care setting. Use of a combination of criteria might capture the highest number of BE patients.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 4","pages":"Pages 347-351"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Recognition and Resection of Malignant Colorectal Polyps","authors":"Natalie Wilson ,&nbsp;Moamen Gabr ,&nbsp;Mohammad Bilal","doi":"10.1016/j.tige.2023.03.001","DOIUrl":"https://doi.org/10.1016/j.tige.2023.03.001","url":null,"abstract":"<div><p><span>Colorectal cancer is the third most common cancer in the United States and the second leading cause of cancer-related death. Colonoscopy with </span>polypectomy<span><span> reduces the incidence and mortality of colorectal cancer, and with the growing number of advanced endoscopic resection techniques, select malignant polyps can now be managed endoscopically. Optimal management of malignant </span>colorectal polyps<span> involves careful assessment of the polyp based on morphologic and surface features to determine the risk of submucosal invasion. Lesions with features of deep submucosal invasion typically require surgical resection, although in the absence of these features, superficially invasive lesions are often amenable to endoscopic resection with techniques such as endoscopic mucosal resection<span>, endoscopic submucosal dissection, and, more recently, endoscopic full-thickness resection. These resection techniques should be performed by endoscopists trained in advanced resection modalities.</span></span></span></p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 4","pages":"Pages 385-398"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interobserver Agreement on “Assessment of Debris” During Endoscopic Ultrasound-guided Drainage of Walled-off Pancreatic Necrosis","authors":"Partha Pal ,&nbsp;Sundeep Lakhtakia ,&nbsp;Nitin Jagtap ,&nbsp;Shujaath Asif ,&nbsp;Krithi Krishna Koduri ,&nbsp;Rajesh Gupta ,&nbsp;Jahangeer Basha ,&nbsp;Azimudin Haja ,&nbsp;Aniruddha Pratap Singh ,&nbsp;Ashirwad Pasumarthy ,&nbsp;Zaheer Nabi ,&nbsp;Jagdeesh Rampal Singh ,&nbsp;Rakesh Kalpala ,&nbsp;Mohan Ramchandani ,&nbsp;D Nageshwar Reddy","doi":"10.1016/j.tige.2023.03.003","DOIUrl":"https://doi.org/10.1016/j.tige.2023.03.003","url":null,"abstract":"<div><h3>Background and Aims</h3><p>Estimation of the solid component in walled-off pancreatic necrosis<span> (WOPN) during endoscopic ultrasound (EUS) is an important parameter to guide the selection of stent for drainage but is often not objectively quantified.</span></p></div><div><h3>Methods</h3><p>We aimed to study the interobserver agreement (IOA) among endosonographers assessing debris in the pancreatic fluid collection and their choice of stent. EUS videos of 15 patients having pancreatic fluid collection with concurrent magnetic resonance imaging (MRI) assessment of debris were independently reviewed by 40 endosonographers for the percentage of debris (10% increments) and their choice of stent (plastic or metal). The Fleiss kappa (κ) coefficient was used to assess IOA. Post-hoc analysis was done using wider debris intervals (20% or greater increments).</p></div><div><h3>Results</h3><p>Poor agreement was observed for the percentage of debris (κ = 0.188), which did not improve (κ = 0.196) even after including only expert endosonographers with more than 10 years of experience (n = 33). There was fair agreement (κ = 0.266) with reference MRI on the percentage of debris. On post-hoc analysis, the IOA (κ = 0.56, substantial agreement) and agreement with MRI (κ = 0.59, substantial agreement) improved as the debris intervals widened (&lt;10%, 10%-50%, &gt;50%). The agreement for stent selection (plastic vs metal) was poor (κ = 0.174) and did not improve with case volume (κ = 0.153 among respondents with &gt;25 EUS-guided drainage/year; n = 21) or years of experience (κ = 0.195 for &gt;10-year experience; n = 33).</p></div><div><h3>Conclusion</h3><p>IOA between endosonographers regarding estimation of debris in WOPN and subsequent stent choice for drainage is poor. The experience of endosonographers did not improve IOA. Studies to standardize the EUS criteria for debris assessment in WOPN and subsequent therapeutic approaches are warranted.</p></div>","PeriodicalId":36169,"journal":{"name":"Techniques and Innovations in Gastrointestinal Endoscopy","volume":"25 3","pages":"Pages 213-220"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49749929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}