Division of Gastroenterology and Hepatology, Kansas City VA, 4801 E Linwood Blvd, Kansas City, MO, 64128, USA.
Division of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA.
Dig Dis Sci. 2021 Jan;66(1):231-237. doi: 10.1007/s10620-020-06169-7. Epub 2020 Mar 3.
Biliary strictures are a common complication of donation after circulatory death (DCD) liver transplantation (LT) and require multiple endoscopic retrograde cholangiopancreatography (ERCP) procedures. Three classification systems, based on cholangiograms, have been proposed for categorizing post-LT biliary strictures. We examined the interobserver agreement for each of the three classifications.
DCD LT recipients from 2012 through March 2017 undergoing ERCP for biliary strictures were included in the study. Initial cholangiograms delineating the entire biliary tree prior to endoscopic intervention were selected. One representative cholangiogram was selected from each ERCP. Five interventional endoscopists independently viewed each anonymized cholangiogram and classified the post-LT stricture according to each of the three classification systems. The Ling classification proposes four types of post-LT strictures based on their location. The Lee classification proposes four classes based on location and number of intrahepatic strictures. The binary system classifies strictures into anastomotic or non-anastomotic types. The Krippendorff's alpha reliability estimate was used to grade the strength of agreement as "poor," "fair," "moderate," "good," or "excellent" for values between 0-0.20, 0.21-0.4, 0.41-0.6, 0.61-0.08, and 0.81-1, respectively.
One hundred DCD LT recipients (age 57.07 ± 8.8 years; 71 males) were initially evaluated. Of these, 49 patients who underwent 206 ERCP procedures for biliary strictures were included in the analysis. One hundred thirty-nine cholangiograms were selected and subsequently classified by five endoscopists. Interobserver agreement for post-LT biliary strictures was 0.354 for Ling classification (fair agreement), 0.405 for Lee classification (fair agreement), and 0.421 for the binary classification (moderate agreement). The binary classification provided the least amount of detail regarding the location and number of biliary strictures.
The currently available classification systems for assessing post-LT biliary strictures have sub-optimal interobserver agreement. A better-designed classification system is needed for categorizing post-LT biliary strictures.
在 死后循环死亡（DCD）肝移植（LT）后，胆瘘是一种常见的并发症，需要多次进行内镜逆行胰胆管造影（ERCP）。目前已经提出了三种基于胆管造影的分类系统来对 LT 后胆瘘进行分类。本研究旨在评估这三种分类方法的观察者间一致性。
本研究纳入了 2012 年至 2017 年 3 月期间因胆瘘而行 ERCP 的 DCD LT 受者。选择了在进行内镜干预前能够描绘整个胆道树的初始胆管造影图。每位受检者均从 ERCP 中选择一张具有代表性的胆管造影图。5 位介入内镜医生分别对每张匿名胆管造影图进行了独立评估，并根据三种分类系统中的每一种对 LT 后胆瘘进行了分类。Ling 分类法根据其位置提出了四种 LT 后胆瘘类型。Lee 分类法根据位置和肝内胆管狭窄的数量提出了四种类型。二进制系统则将狭窄分为吻合口或非吻合口类型。Krippendorff's alpha 可靠性估计用于对一致性强度进行分级，取值范围为 0-0.20、0.21-0.4、0.41-0.6、0.61-0.08 和 0.81-1 时，分别表示“差”、“一般”、“中等”、“好”或“优”。
最初评估了 100 例 DCD LT 受者（年龄 57.07±8.8 岁；71 例男性）。其中，49 例患者因胆瘘接受了 206 次 ERCP 治疗，纳入了分析。选择了 139 张胆管造影图，并由 5 位内镜医生进行了分类。LT 后胆瘘的观察者间一致性 Ling 分类为 0.354（一般一致性），Lee 分类为 0.405（一般一致性），二进制分类为 0.421（中等一致性）。二进制分类在描述胆管狭窄的位置和数量方面提供的信息最少。
目前用于评估 LT 后胆瘘的分类系统观察者间一致性较差。需要设计更好的分类系统来对 LT 后胆瘘进行分类。
