The endoscopic ultrasound features of pancreatic fluid collections and their impact on therapeutic decisions: an interobserver agreement study

Abstract

Background and study aims: A validated classification of endoscopic ultrasound (EUS) morphological characteristics and consequent therapeutic intervention(s) in pancreatic and peripancreatic fluid collections (PFCs) is lacking. We performed an interobserver agreement study among expert endosonographers assessing EUS related PFCs features and therapeutic approaches utilized. Patients and methods: Fifty EUS videos of PFCs were independently reviewed by 12 experts and evaluated for PFC type, percentage of solid component, presence of infection, recognition and communication of the main pancreatic duct (MPD), stent choice for drainage, and direct endoscopic necrosectomy (DEN) performance and timing. The Gwet’s AC1 coefficient was used to assess interobserver agreement. Results: A moderate agreement was found for lesion type (AC1, 0.59), presence of infection (AC1, 0.41), and need for DEN (AC1, 0.50), while fair or poor agreements were stated for percentage of solid component (AC1, 0.15) and MPD recognition (AC1, 0.31). Substantial agreement was rated for ability to assess PFC-MPD communication (AC1, 0.69), decision between placing a plastic versus lumen-apposing metal stent (AC1, 0.62), and timing of DEN (AC1, 0.75). Conclusions: Interobserver agreement between expert endosonographers regarding morphological features of PFCs appeared suboptimal, while decisions on therapeutic approaches seemed more homogeneous. Studies to achieve standardization of the diagnostic endosonographic criteria and therapeutic approaches to PFCs are warranted.

Endoscopic ultrasound as a reliable tool for assessment of pancreatic adenocarcinoma treatment: Example of in situ gene therapy

“…The latter often infiltrates adjacent structures, has irregular contours, and is associated with pseudopods; hence, it is difficult to obtain an accurate measurement of the tumor diameter. Despite the fact that several interobserver agreement studies have been conducted with EUS for diagnosis of pancreatic diseases such as chronic pancreatitis and accumulation of pancreatic fluid, very few have included solid pancreatic masses, especially PDAC 8 9 10 11 12 13 14 . Moreover, only endosonographers have taken part in these pilot or multicenter studies, and no radiologists were included in the panel of experts.…”

The endoscopic ultrasound features of pancreatic fluid collections: appearances can be deceptive!

“…The authors shared shortduration EUS videos of 50 patients with a PFC, without their clinical correlates, that were independently reviewed by 12 experts and evaluated for eight features: five diagnostic (type of collection, percentage solid debris, presence of infection, main pancreatic duct [MPD] recognition, and PFC-MPD communication) and three therapeutic (type of stent for drainage, and the requirement for DEN and its timing). The study reported poor interobserver agreement for all of the morphological features of PFCs examined (except for PFC-MPD communication), which is not unusual given the subjective nature of EUS evaluation, including crucially the assessment of debris [3]. Notably, even the landmark studies did not mention the methods for measurement of percentage debris [4,5].…”

“…There were no available data from interobserver agreement studies on the morphological characterization of PFCs and the subsequent therapeutic decisions. The study by Fabbri et al address the knowledge gap on some of the parameters in this interobserver agreement study [3].…”

“…Can EUS provide a percentage estimation of the debris in WON with reasonable accuracy? To answer this question, Fabbri et al in their study focused on determining interobserver agreement for the morphology of PFCs by EUS and the subsequent management strategies [3]. The authors shared shortduration EUS videos of 50 patients with a PFC, without their clinical correlates, that were independently reviewed by 12 experts and evaluated for eight features: five diagnostic (type of collection, percentage solid debris, presence of infection, main pancreatic duct [MPD] recognition, and PFC-MPD communication) and three therapeutic (type of stent for drainage, and the requirement for DEN and its timing).…”

To-and-fro balloon technique for deployment of a lumen-apposing metal stent in highly solid walled-off necrosis of the pancreas

“…Lumen-apposing metal stents (LAMSs) have revolutionized endoscopic treatment of walled-off necrosis (WON) by allowing for effective drainage and subsequent endoscopic necrosectomy [1,2]. However, it may be technically challenging to deploy a LAMS for a WON with little fluid content [3], which potentially inhibits insertion of the delivery and expansion of the distal stent flange [4]. A 38-year-old woman was referred to our department for endoscopic management of an infected WON due to biliary pancreatitis (▶ Fig.…”