Columbia University Medical Center, New York City.
Department of Medicine, Rutgers Robert Wood Johnson Medical School, The State University of New Jersey, Robert Wood Johnson University Hospital, New Brunswick, NJ.
J Clin Gastroenterol. 2022 Feb 1;56(2):e94-e97. doi: 10.1097/MCG.0000000000001321.
Visual characteristics seen during digital single-operator cholangioscopy (DSOC) have not been validated. The aim of this 2-phase study was to define terminology by consensus for the visual diagnosis of biliary lesions to develop a model for optimization of the diagnostic performance of DSOC.
In phase 1 (criteria identification), video-cholangioscopy clips were reviewed by 12 expert biliary endoscopists, who were blinded to the final diagnosis. Visual criteria were consolidated into the following categories: (1) stricture, (2) lesion, (3) mucosal features, (4) papillary projections, (5) ulceration, (6) abnormal vessels, (7) scarring, (8) pronounced pit pattern.During the second phase (validation), 14 expert endoscopists reviewed DSOC (SpyGlass DS, Boston Scientific) clips using the 8 criteria to assess interobserver agreement (IOA) rate.
In phase 1, consensus for visual findings were categorized into 8 criteria titled the "Monaco Classification." The frequency of criteria were: (1) presence of stricture-75%, (2) presence of lesion type-55%, (3) mucosal features-55%, (4) papillary projections-45%, (5) ulceration-42.5%, (6) abnormal vessels-10%, (7) scarring-40%, and (8) pronounced pit pattern-10%. The accuracy on final diagnosis based on visual impression alone was 70%.In phase 2, the IOA rate using Monaco Classification criteria ranged from slight to fair. The presumptive diagnosis IOA was fair (κ=0.31, SE=0.02), and overall diagnostic accuracy was 70%.
The Monaco classification identifies 8 visual criteria for biliary lesions on single-operator digital cholangioscopy. Using the criteria, the IOA and diagnostic accuracy rate of DSOC is improved compared with prior studies.
数字单操作员胆管镜检查（DSOC）中观察到的视觉特征尚未得到验证。本研究的目的是通过共识来定义胆道病变的视觉诊断术语，以建立优化 DSOC 诊断性能的模型。
在第 1 阶段（标准识别）中，12 名胆道内镜专家在不了解最终诊断的情况下对视频胆管镜检查片段进行了回顾。视觉标准被整合为以下几类：（1）狭窄；（2）病变；（3）黏膜特征；（4）乳头突起；（5）溃疡；（6）异常血管；（7）瘢痕；（8）明显的凹坑模式。在第 2 阶段（验证）中，14 名专家内镜医生使用 8 个标准回顾 DSOC（SpyGlass DS，Boston Scientific）片段，以评估观察者间一致性（IOA）率。
在第 1 阶段，将视觉发现的共识分为 8 个标准，称为“摩纳哥分类”。标准的出现频率为：（1）狭窄存在-75%；（2）病变类型存在-55%；（3）黏膜特征-55%；（4）乳头突起-45%；（5）溃疡-42.5%；（6）异常血管-10%；（7）瘢痕-40%；（8）明显的凹坑模式-10%。仅基于视觉印象的最终诊断准确率为 70%。在第 2 阶段，使用 Monaco 分类标准的 IOA 率从轻微到公平不等。推测诊断的 IOA 为公平（κ=0.31，SE=0.02），整体诊断准确性为 70%。
Monaco 分类法确定了单操作员数字胆管镜检查中胆道病变的 8 个视觉标准。使用这些标准，与先前的研究相比，DSOC 的 IOA 和诊断准确性得到了提高。
